TOTAKE  CARE  OFTHE  BABY 


■  lANCIS   TWEDDBLL  M.D. 


IRD    EDITION 
EVISED  AND    ENLARGED 


I 
I 

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Presented  by  | 

f 
Gfaoo  -p.   Bell,    "n,    o.  | 


COLLEGE  OF  OSTEOPATHIC   PHYSICIANS 
AND  SURGEONS  •  LOS  ANGELES,  CALIFORNIA 


N-ffi?'t?^,i»?Vt^y^ji?Affi7^ti?7Y^^ 


^HOW  TO  TAKE 
CARE  OF  THE  BABY    > 


A  MOTHER'S  GUIDE  AND 
MANUAL  FOR  NURSES 


By 
FRANCIS  TWEDDELL,  M.D. 

ALUMNUS  BELLEVUE  HOSPITAL,  NEW  YORK,  FELLOW  OF  THE 

NEW  YORK  ACADEMY  OF  MEDICINE,  LATE  PHYSICIAN 

TO  THE  babies'  HOSPITAL  DISPENSARY,  NEW  YORK 


THIRD  EDITION 
REVISED  AND  ENLARGED 


THE  BOBBS-MERRILL  COMPANY 

PUBLISHERS 


Copyright  1913-1915 
The  Bobbs-Merrill  Company 


i1  IS' 


Printed  in  the  Vnited  States  of  America 


PRESS    OF 

BRAUNWORTH   &  CO. 

BOOKBINDERS    AND    PRINTERS 

BROOKLYN.    N.    V. 


TO 

JOSEPHINE  HEMENWAY,  M.D. 

HOUSE  PHYSICIAN  OF  THE  BABIES'  HOSPITAL.   NEW  YORK,   SINCE  1906 

THIS  LITTLE  BOOK  IS  DEDICATED 

AS  A  MARK  OF  ESTEEM,  AND  GRATITUDE  FOR  MANY  FAVORS. 

BY  THE  AUTHOR 


\  'O 


1 

^  PREFACE  TO  THE  FIRST  EDITION 

J 

*i  

In  presenting  this  little  book  to  the  public,  the  author's 
aim  is  to  give  simple,  clear,  and  complete  directions,  espe- 
<^cially  as  regards  nursing  and  artificial  feeding  of  infants, 
<;?j3nd  disorders  of  digestion. 

r-  The  chapters  are  complete  in  themselves,  and  the  head- 
's ings  have  been  so  arranged  as  to  render  a  search  for 
?7information  on  any  subject  an  easy  matter. 

.  F.  T. 

1^    71  West  68th  Street, 
New  York. 

\  July  12th,  1911. 


3  I 


fT'     r~"   O 


\ 


PREFACE  TO  THE  THIRD  EDITION 


In  the  present  edition  the  general  arrangement  is  the 
same,  but  the  whole  matter  has  been  subjected  to  careful 
revision,  and  some  additions  have  been  made,  notably  in 
respect  to  feeding. 

More  attention  has  been  paid  to  older  children  suffer- 
ing from  loss  of  appetite  and  minor  ailments,  which  are 
often  entirely  overlooked  until  more  serious  conditions 
develop. 


F.  T. 


Summit,  N.  J. 
1915. 


CONTENTS 

PAGE 

The  Nursery 1 

The  Baby's  Bed 3 

Clothing    4 

List  of  Clothing 6 

Care  of  Napkins 7 

How  to  Lift  the  Baby 7 

Bathing   8 

Care  of  Eyes 13 

Care  of  Genitals 13 

Airing    14 

Exercise    16 

Sleep    17 

Nursing  21 

Wet-Nursing   32 

Weaning    36 

Artificial    Feeding 39 

Additional  Food  During  the  First  Year 62 

Protein  Milk 63 

Peptonized  Milk 65 

Buttermilk    65 

SteriHzation  and  Pasteurization  of  Milk 66 

Diet  from  the  Second  to  the  Tenth  Year 63 

Loss  of  Appetite 73 

Forbidden  Articles  of  Food 77 

Stools  77 

Indigestion    80 

Colic  and  Wind 85 

Vomiting    86 

Diarrhea   90 

Constipation  95 

Malnutrition  and  Marasmus 100 

Colds    103 

Bronchitis    106 

Hiccough    103 

Spasmodic    Croup 103 


CONTENTS— Co«/;«w^ 

PAGE 

Ear-ache  109 

Sprue  or  Thrush 110 

Enlarged    Glands Ill 

Adenoids  Ill 

Tonsils    112 

Worms    112 

Night  Terrors 113 

The  Retention  of  Urine 114 

Jaundice    115 

The  Temperature 115 

Examination  of  Throat 116 

Training  of  Bowels  and  Bladder 118 

Development    120 

Dentition  123 

Vaccination    128 

Circumcision    128 

The   Cry 129 

Kissing  and  Playing  with  Babies 130 

Toys    131 

Bad  Habits    132 

Milk  in  Infants'  Breasts 134 

Accidents    v  134 

Convulsions   136 

Rickets    138 

Scurvy    139 

Pneumonia   140 

The  Sickroom  in  Contagious  Diseases 142 

Contagious    Diseases 145 

Diseases  of  the  Skin 151 

Food    Recipes 154 

Measures    158 

Common  Remedies 158 

Injections,  Suppositories  and  Irrigations 160 

Don't    162 


HOW  TO  TAKE  CARE  OF 
THE  BABY 


How  to  Take  Care  of 
the  Baby 


iTHE  NURSERY 

Location  and  Furnishings. — The  nursery  should  be 
a  large,  airy  room,  above  the  ground  floor,  and  with  a 
southern  exposure.  Plenty  of  light,  air  and  sunshine 
are  essential  to  the  baby's  welfare.  The  furniture  ought 
to  be  of  the  simplest,  with  no  upholstery ;  the  bed  of 
enamelled  iron  or  brass,  and  the  draperies  of  light,  wash- 
able materials. 

At  the  windows,  both  light  and  dark  shades  are  needed, 
as  the  new-born  infant  is  very  susceptible  to  light  and 
therefore  for  the  first  few  weeks  the  nursery  should  be 
kept  darkened. 

The  floor  should  not  be  carpeted,  only  a  few  light 
rugs  placed  where  they  are  most  needed,  and  care  must 
be  taken  to  keep  these  scrupulously  clean.  No  stationary 
washbasins  or  plumbing  of  any  kind  must  be  allowed 
in  the  room.  Furniture  and  floors  should  be  wiped  daily 
with  damp  cloths,  and  not  dusted. 

Ventilation. — Particular  attention  must  be  paid  to 
the  ventilation,  which  can  be  secured  at  all  times  without 
a  draft  by  means  of  a  window  board  about  five  or  six 
inches  wide  and  long  enough  to  fit  the  window  exactly 
when  the  lower  sash  is  raised  to  insert  it.    This  admits 


7       HOW  TO  TAKE  CARE  OF  THE  BABY 

of  a  free  passage  of  air  upward  into  the  room  between 
the  upper  and  lower  sashes. 

In  addition  to  this,  the  nursery  should  always  be  aired 
for  at  least  an  hour,  morning  and  evening,  after  the 
bath,  and  just  before  going  to  bed;  while  this  is  being 
done,  the  baby  must  be  taken  into  another  room. 

No  cooking,  washing  or  drying  of  clothes  should 
ever  be  permitted  in  the  nursery  at  any  time. 

Heating. — The  system  of  hot  water  heating  is  un- 
doubtedly the  best,  and  open  fires  when  the  weather  is 
not  very  cold,  but  it  is  not  always  possible  to  obtain  these. 
When  steam  or  hot  air  is  used,  a  pan  of  water  should 
always  be  kept  in  the  room  to  prevent  excessive  dryness 
of  the  atmosphere.  Iron,  gas,  or  oil  stoves  are  the  worst 
methods  of  heating,  and  ought  never  to  be  used. 

The  Temperature. — The  temperature  of  the  room 
should  be  kept  at  about  70 °F.  by  day,  and  at  night  never 
above  64°F.  even  for  a  young  baby;  and  as  the  child 
grows  older,  this  can  be  gradually  reduced  until  he  be- 
comes accustomed  to  sleeping  in  a  cold  room.  The 
window  should  be  partly  opened  top  and  bottom  at  night, 
more  or  less,  according  to  the  weather,  beginning  from 
the  time  the  child  is  two  or  three  months  old,  if  the 
temperature  outside  is  not  freezing.  After  the  age  of 
six  months  it  should  be  opened  in  any  weather,  unless 
the  child  is  delicate  or  ill. 

Care  must  be  taken  that  the  cold  air  does  not  blow 
directly  on  the  baby,  and  that  he  has  sufficient  covering. 
With  the  exception  of  the  mother  or  nurse,  no  one  else 
should  be  allowed  to  sleep  in  the  room. 

Danger  of  Too  Much  Heat. — Although  it  is  essential 
to  keep  a  child  thoroughly  warm,  a  great  deal  of  harm 
can  be  done  by  keeping  the  nursery  too  hot.  A  child 
kept  in  hot  rooms  loses  his  appetite,  becomes  pale,  per- 
spires easily,  loses  weight,  and  is  subject  to  colds  and 
indigestion. 


A  MOTHER'S  GUIDE  3 

Lighting. — No  gas  should  be  allowed  to  burn  in  the 
nursery  at  night,  and  where  there  is  no  electric  light, 
a  wax  night  light  should  be  used. 

Screens. — In  summer,  the  windows  of  the  nursery 
should  be  fitted  with  screens  to  keep  out  flies  and  mos- 
quitoes. Some  babies  are  badly  poisoned  by  mosquito 
bites,  and  one  kind  of  mosquito  can  give  the  child  ma- 
laria. 

Flies  are  dangerous  because  they  may  alight  on  the 
nipple  of  the  baby's  bottle  or  on  the  food,  and  a  fly's 
feet  can  bring  germs  from  wherever  their  last  resting 
place  may  have  been.  Contagious  diseases  and  other  ail- 
ments are  often  transported  in  this  way. 

THE  BABY^S  BED 

Bed  and  Bedding. — From  the  first  a  baby  ought  to 
have  a  separate  bed  of  brass  or  enamelled  iron  which 
does  not  rock.  The  mattress  should  be  of  hair,  and 
covered  with  an  India-rubber  sheet,  then  a  cotton  pad, 
and,  finally  a  cotton  (not  a  linen)  sheet.  For  the  first 
few  weeks  it  is  better  for  the  infant  to  lie  with  his  head 
low;  a  pad  doubled  under  the  head  is  sufficient;  after 
this  a  small  hair  pillow  is  best,  as  feathers  are  too  heat- 
ing. 

For  coverings  use  a  cotton  sheet,  warm  woolen  blan- 
kets, and  when  necessary,  an  eiderdown  quilt.  Have  all 
coverings  sufficiently  warm,  but  light,  and  never  keep 
him  so  hot  that  he  perspires,  as  this  is  very  weakening, 
and  predisposes  him  to  catching  cold.  If  the  feet  are 
cold,  a  hot  water  bottle  covered  with  a  flannel  bag  should 
be  placed  in  the  bed  near  them,  but  take  great  care  that 
it  is  not  hot  enough  to  burn  the  skin. 

Care  of  the  Bedding. — All  the  bedding  should  be 
thoroughly  aired  and  exposed  to  the  sun  every  day,  and 
the  mattress  and  pillows  shaken  and  turned.     Sheets 


4   HOW  TO  TAKE  CARE  OF  THE  BABY 

and  pads  which  have  become  wet  or  soiled  should  never 
be  used  a  second  time  before  washing,  and  care  must 
be  taken  that  they  are  thoroughly  dry  before  making 
up  the  bed. 

Location  of  Crib. — The  crib  should  be  placed  in 
such  a  manner  that  the  light  will  not  fall  directly  on  the 
baby's  eyes,  and  never  between  two  windows  or  doors, 
or  where  a  draft  can  blow  directly  over  him.  A  screen 
placed  around  the  bed  is  very  useful  in  preventing  this. 

CLOTHING 

General  Directions. — ^The  clothing  for  infants  should 
be  extremely  simple,  and  moderately  snug-fitting,  so 
that  there  shall  be  no  wrinkles  to  hurt  the  baby,  and  at 
the  same  time  they  should  be  loose  enough  to  admit  of 
free  circulation  and  unhampered  movements. 

Underwear. — In  winter,  wool  is  the  best  material 
for  undergarments  for  babies,  but  with  an  admixture  of 
silk  or  cotton,  and  not  of  the  heaviest  grade,  as  too  thick 
garments  will  make  a  child  delicate  and  very  sensitive 
to  changes,  and  are  quite  unnecessary  even  in  winter  if 
the  nursery  is  kept  at  the  proper  temperature.  When 
the  baby  is  taken  out  for  an  airing,  changes  in  tempera- 
ture must  be  met  by  sufficient  outer  wraps. 

In  summer  the  underwear  should  be  of  the  lightest 
grade  of  silk  and  wool,  or  cotton  and  wool. 

For  the  first  two  months,  an  infant  should  wear  a 
plain  flannel  band  rolled  smoothly  about  the  abdomen 
and  sewn,  not  fastened  with  safety  pins.  This  is  later 
replaced  by  the  knitted  band  with  straps  over  the  shoul- 
ders. Over  this,  in  winter,  is  worn  the  woolen  under- 
vest  with  long  sleeves  and  high  neck.  The  diaper  is 
then  pinned  to  the  bottom  of  the  vest  to  prevent  the 
shirt  from  working  up  about  the  body,  and  also  to  keep 
the  diaper  from  slipping  down.     Diapers  should  be  of 


'A   MOTHER'S   GUIDE  5 

bird's-eye  cotton,  or  of  stockinet,  but  not  of  linen.  In 
summer,  the  undervest  can  be  omitted,  and  the  diaper 
pinned  to  the  band.  Rubber  diapers  should  never  be 
used  except  for  a  short  time  when  traveling,  as  they 
act  like  poultices  when  wet. 

Foot  Covering. — The  baby's  feet  should  be  covered 
with  knitted  or  crocheted  bootees,  and  care  taken  that 
the  feet  are  always  perfectly  warm.  In  summer  the 
bootees  are  replaced  by  soft  kid  ones,  and  thin  socks 
worn  under  them  next  to  the  skin. 

Outer  Garments. — The  flannel  skirt  should  be  sup- 
ported from  the  shoulders,  and  not  pinned  about  the 
body  on  a  tight  band ;  then  a  simple  little  dress,  prefer- 
ably of  nainsook,  and  if  the  weather  is  very  cold,  either 
a  knitted  or  a  flannel  jacket.  For  the  first  three  weeks, 
a  soft  cashmere  or  woolen  shawl  should  be  wrapped 
about  the  baby,  covering  the  head  as  well. 

Coat,  Cap  and  Mittens. — When  the  baby  is  taken 
for  an  airing,  his  coat  should  be  very  warm  and  soft, 
but  not  heavy,  and  the  cap  preferably  of  silk  with  an 
interlining  of  flannel;  caps  which  are  so  warm  as  to 
induce  perspiration  must  be  avoided,  and  equally  so  the 
muslin  cap  or  bonnet  which  does  not  give  sufficient 
warmth  in  cold  weather.  In  winter  the  child's  hands 
should  be  covered  with  woolen  mittens,  securely  pinned 
to  the  sleeves  of  his  coat. 

Night  Garments. — A  baby's  night  garments,  after 
he  has  passed  the  stage  of  infancy,  when  they  are  very 
much  the  same  as  those  worn  in  the  daytime,  should 
consist  of  a  shirt,  and  a  woolen  union  suit  with  feet. 

Bare  Legs. — It  is  not  advisable  to  allow  children  of 
any  age  to  go  barelegged,  except  in  very  hot  weather, 
and  then,  the  fewer  clothes  they  wear  the  better,  as 
they  will  not  be  so  weakened  by  the  heat. 

Short  Clothes. — I  advise  a  length  of  twenty-two 
inches  at  birth  and  made  with  fairly  wide  shoulders. 


6   HOW  TO  TAKE  CARE  OF  THE  BABY 

They  should  last  through  the  first  year.  Long  stockings 
must  be  provided  for  short  clothes.  No  child  should  be 
kept  in  long  clothes  beyond  the  first  few  months,  as  they 
hamper  its  movements. 

Clothing  of  Older  Children. — As  a  child  gets  older, 
and  takes  more  exercise,  his  clothing  ought  to  be  lighter, 
especially  in  the  house,  and  his  underwear  should  be 
principally  of  cotton.  Woolen  stockings  ought  never  to 
be  used,  as  they  cause  the  feet  to  perspire  and  become 
easily  chilled.  Leather  leggings  are  not  to  be  recom- 
mended for  the  same  reason.  Older  children  should 
gradually  discontinue  wearing  woolen  garments  next 
to  the  skin.  , 

List  of  Clothing  for  a  Young  Baby 

The  following  list  is  about  the  smallest  amount  of 
clothing  that  will  suffice  for  a  young  baby  and  should  be 
in  readiness  when  the  child  is  born: 

Four  dozen  diapers. 

1  yd.  white  flannel  for  binders. 

4  silk  and  wool,  or  cotton  and  wool  shirts. 

5  flannel  petticoats. 

10  plain  slips  for  night  and  day  use,  during  the  first 
five  or  six  weeks. 

4  pairs  knitted  or  crocheted  bootees. 
3  knitted  or  flannel  sacques. 

2  soft  shawls. 
1  warm  cloak. 
1  hood. 

1  pair  mittens. 

After  the  first  six  weeks  four  knitted  bands  with  shoul- 
der straps  will  be  required  to  replace  the  flannel  bands, 
and  six  plain  little  dresses  for  use  in  the  daytime. 

Complete  layettes  can  be  had  at  various  prices  at  any 
of  the  large  dry-goods  stores. 


A   MOTHER'S   GUIDE 


CARE  OF  THE  NAPKINS 

All  wet  napkins  must  be  removed  at  once  from  the 
nursery  and  put  to  soak  in  a  pail  of  water  with  a  cover 
until  the  time  for  their  daily  washing  arrives.  If  they 
are  soiled,  they  should  receive  a  rough  washing  at  once. 
They  ought  to  be  thoroughly  boiled,  washed  and  ironed 
once  a  day,  and  care  must  be  taken  that  all  napkins  are 
perfectly  dry  before  using.  A  napkin  should  never  be 
used  a  second  time  until  it  has  been  thoroughly  washed. 


MANNER  OF  LIFTING  A  BABY 

HOW  TO  LIFT  A  BABY 

Lifting  a  New-born  Infant. — A  new-born  infant 
should  be  handled  very  little,  that  is,  no  more  than  is 
absolutely  necessary  in  bathing  and  caring  for  him,  and 


8   HOW  TO  JAKE  CARE  OF  THE  BABY 

when  changing  his  position  from  time  to  time  while 
lying  in  the  crib. 

In  lifting  a  young  baby  never  grasp  him  around  the 
chest  or  abdomen.  The  best  way  is  to  catch  hold  of 
his  clothing  below  the  feet  with  the  right  hand,  and  lay 
the  palm  of  the  left  hand  under  his  back,  with  the  fingers 
extended  under  his  head  and  neck.  In  this  way  the  en- 
tire spine  and  head  will  be  supported. 

Never  lift  a  baby  under  six  months  old  without  sup- 
porting his  head. 

Lifting  Older  Children. — Older  children  should  be 
lifted  by  grasping  the  body  under  the  arm-pits,  never 
by  the  wrists  or  arms.  Serious  injury  is  often  inflicted 
by  lifting  a  child  in  this  way. 

BATHING 

Bathing  the  First  Few  Days. — For  the  first  few 
days  after  birth  an  infant  should  be  carefully  soaped 
and  sponged  with  water  at  100 °F.  while  lying  on  the 
nurse's  lap,  and  only  a  small  part  exposed  at  a  time,  in 
order  to  prevent  the  baby's  catching  cold.  Care  must 
be  taken  not  to  uncover  or  wet  the  navel.  When  the 
cord  falls  off  and  the  navel  heals,  which  usually  occurs 
before  the  tenth  day,  the  full  tub  bath  should  be  given 
daily,  and  preferably  in  the  morning,  about  two  hours 
after  the  first  feeding. 

Time  for  a  Bath. — This  time  is  most  convenient  as 
the  baby  will  then  receive  his  next  feeding  soon  after 
the  bath,  and  will  usually  go  to  sleep  immediately  after. 
After  the  fourth  month  there  is  no  objection  to  giving 
the  bath  just  before  bedtime,  but  never  less  than  an  hour 
after  a  meal ;  in  that  case  a  little  sponging  in  the  morning 
is  necessary. 

Directions  for  Bathing. — The  temperature  of  the 
room  in  which  the  bath  is  to  be  given  should  be  not  less 


A   MOTHER'S   GUIDE  9 

than  70° F.  and  it  is  better  to  give  it  in  front  of  an  open 
fire,  if  possible.  The  temperature  of  the  bath  must  be 
between  98°  and  100°F.  for  the  first  six  months;  after 
that,  it  can  be  given  at  95°  ;  a  much  lower  temperature 
than  this  is  not  sufficient  for  cleansing  purposes. 

Articles  Required. — The  following  articles  are  re- 
quired, and  should  be  in  readiness  before  beginning  the 
baby's  bath,  so  that  it  may  be  given  quickly  and  without 
interruption. 

An  oblong  rubber  or  tin  bath-tub  placed  on  a  low 
table.  Bath  thermometer.  A  low  rocker  without  arms 
for  mother  or  nurse.  A  rubber  apron  for  mother  or 
nurse,  and  a  large  piece  of  flannel  or  flannel  apron  to 
be  worn  over  it.  On  a  table  close  at  hand  should  be 
placed  the  soap,  either  castile  or  a  very  fine  toilet  soap, 
soft  towels  for  drying,  a  threaded  needle  for  sewing 
bands,  scissors,  soft  hair  brush,  absorbent  cotton  or  soft 
lint  in  small  squares,  a  cup  containing  a  solution  of  warm 
boric  acid  (one  teaspoonful  to  a  pint),  talcum  powder,  a 
piece  of  aseptic  gauze,  and  a  soft  washcloth  instead  of  a 
sponge,  as  the  latter  can  never  be  kept  clean  enough  to 
make  it  safe  for  a  baby's  use.  In  case  of  chafing,  Sal- 
vacea  or  zinc  oxide  ointment  can  be  applied  instead  of  the 
dusting-powder.  The  baby's  clothes  should  be  slightly 
warmed,  and  hung  in  readiness  on  a  clothes-rack  near  by. 

How  to  Give  the  Bath. — The  bath-tub  should  then 
be  filled  two-thirds  full,  and  after  the  temperature  is 
regulated,  the  baby  is  taken  into  the  mother's  or  nurse's 
lap  and  carefully  undressed.  A  table  with  a  raised  edge 
can  be  used  instead  of  the  lap.  Undressing  can  be  done 
with  very  little  turning  or  lifting;  lay  the  child  flat  on 
his  stomach  while  unfastening  his  garments  at  the  back, 
then  turn  him  once  over,  roll  his  garments  up  and  re- 
move them  over  his  head ;  he  can  thus  be  completely 
undressed  with  very  little  handling. 

He  should  be  wrapped  in  the  warm  flannel  apron 


10  HOW  TO  TAKE  CARE  OF  THE  BABY 


while  his  eyes  are  washed  with  a  bit  of  absorbent  cot- 
ton dipped  in  boric  acid  solution,  then  his  face  washed 
in  the  warm  water,  and  after  that  the  head  and  ears 
be   soaped   with  the  piece   of   gauze,   washed   and 


can 


thoroughly  dried.  When  this  is  finished,  the  rest  of  the 
body  is  soaped,  and  he  is  then  carefully  lifted  into  the 
bath.  With  a  young  infant,  care  must  be  taken  to  sup- 
port his  back  and  head  with  the  left  hand,  while  the 


LIFTING  A  BABY  IN  AND  OUT  OF  A  BATH 

right  hand  grasps  the  ankles.  The  baby  is  placed  in 
a  semi-reclining  position  in  the  tub,  and  ^  the  body 
sponged.  Particular  care  should  be  taken  in  soaping 
and  washing  the  genitals  with  a  separate  washcloth,  as 
scrupulous  cleanliness  is  very  essential  to  the  health  of 
these  parts.  The  baby  should  not  be  kept  in  the  water 
longer  than  three  or  four  minutes.  If  a  child  shows 
any  fear  of  the  bath  it  is  a  good  plan  to  put  a  sheet  over 
the  tub  and  then  gently  lower  him  in  it  into  the  water. 


A   MOTHER'S   GUIDE  11 

Now  put  the  towel  on  top  of  the  flannel  apron,  take 
the  baby  out  of  the  bath,  lifting  him  carefully  in  the 
same  manner  as  before,  and  roll  him  in  the  bath-towel 
and  apron.  Dry  him  thoroughly,  but  without  rubbing, 
then  dust  him  with  a  little  powder,  paying  particular 
attention  to  the  creases,  put  on  his  band,  diaper  and 
then  the  clothes.  Never  put  his  clothes  on  over  his 
head,  but  draw  them  over  the  feet,  catch  hold  of  the 
feet  and  elevate  the  body  slightly,  then  pull  them  all  the 
way  up;  the  sleeves  can  then  be  drawn  on  with  greater 
ease. 

Cleansing  of  Mouth,  Nose  and  Ears. — When  the 
baby  is  dressed  the  mouth  should  be  carefully  cleaned 
with  a  boric  acid  solution  by  means  of  a  swab  made 
from  absorbent  cotton  twisted  around  a  toothpick. 

The  ears  and  nose  should  be  examined,  and  treated 
in  the  same  manner,  but  with  the  utmost  gentleness, 
and  of  course,  using  a  clean  swab  in  each  case. 

Chafing  of  Skin. — Chafing  is  caused: 

a.  by  not  drying  the  skin  properly, 

b.  by  rubbing  it  too  long  or  too  vigorously, 

c.  by  using  too  much  soap,  or  too  strong  a  soap, 

d.  by  hard  water  containing  much  lime, 

e.  by  too  many  clothes  and  constant  perspiration. 

To  remedy  this  condition  give  bran  baths  for  the  next 
few  days  and  use  plenty  of  dusting  powder,  or  rub  some 
cocoa-butter  on  the  skin. 

Bran  Bath. — The  daily  bath  should  never  be 
omitted,  except  in  the  case  of  severe  illness  or  some 
skin  trouble,  such  as  eczema.  Soap  should  not  be  used 
on  children  suffering  from  prickly  heat.  In  its  place  a 
cupful  of  bran  tied  in  a  muslin  or  cheesecloth  bag  should 
be  squeezed  for  a  few  minutes  in  the  water  and  stirred 
until  it  has  a  milky  appearance.  With  infants  that  have 
very  delicate  skins  the  bran  bath  can  be  continually 
used. 


12     HOW  XQ  PTAKE  CARE  OF  THE  BABY 

Soda  or  Starch  Bath. — If  a  child  has  hives  or  heat- 
rash  a  soda  or  starch  bath  is  very  soothing.  If  soda  is 
used  a  tablespoonful  of  bicarbonate  of  soda  should  be 
added  to  the  water;  if  starch,  a  half-cupful  of  pow- 
dered laundry  starch.  These  baths  should  replace  the 
use  of  soap  for  a  few  days  when  the  buttocks  are  chafed, 

Salt-Bath. — A  salt-bath  is  useful  in  the  case  of  deli- 
cate children,  and  is  prepared  by  adding  a  teacupful  of 
common  salt  or  sea  salt  to  each  two  gallons  of  water. 

Sponge-Bath. — Sponge-baths  are  very  useful  in 
cases  of  fever,  and  also  give  great  relief  to  infants  and 
children  in  very  hot  weather,  and  will  insure  a  good 
night's  rest  to  a  child  who  would  otherwise  be  restless 
and  uncomfortable.  In  the  case  of  fever,  the  addition 
of  alcohol,  about  one  part  alcohol  to  three  parts  warm 
water,  to  a  sponge-bath  is  often  useful  in  reducing  the 
temperature.  Do  not  use  cold  water,  as  it  causes  too 
much  shock.  Some  children  object  to  sponge-baths ;  in 
that  case  give  the  ordinary  tub-bath,  making  it  a  little 
cooler  than  usual. 

Mustard  Bath. — A  mustard  bath  is  sometimes  used 
in  convulsions  and  prostration.  It  is  prepared  by  adding 
a  heaping  tablespoonful  of  mustard  to  five  or  six  gal- 
lons of  warm  water.  But  first  mix  the  mustard  in  a  cup 
or  bowl  with  a  little  water  and  make  it  into  a  smooth 
paste,  then  add  it  to  the  bath,  otherwise  there  is  danger 
of  particles  of  mustard  adhering  to  the  skin  and  causing 
burns.  The  child  should  not  be  kept  in  it  longer  than 
five  minutes,  and  care  must  be  taken  that  none  of  the 
water  gets  into  the  eyes. 

Cold  Douches. — Cold  water  should  never  be  used 
for  bathing  children  under  three  years  of  age,  but  be- 
yond that  age  it  is  often  useful  in  the  form  of  douches 
applied  to  the  throat  and  chest,  or  spine,  for  the  pur- 
poses of  strengthening  them,  and  followed  by  vigorous 
friction. 


A  MOTHER'S  CrUIDE  13 

CARE  OF  THE  EYES 

Eyes  of  a  New-Born  Infant. — The  eyes  of  a  new- 
born infant  need  very  careful  cleansing;  carelessness 
in  this  respect  often  leads  to  severe  inflammation  of  the 
eyes,  and  sometimes  blindness. 

For  the  first  two  weeks  they  should  be  cleansed  in 
the  following  manner.  Dissolve  one  teaspoonful  of  boric 
acid  powder  in  a  pint  of  warm  water.  Carefully  separate 
the  lids,  and  squeeze  a  little  of  the  warm  solution  into 
the  eye  from  a  piece  of  absorbent  cotton,  and  wash  the 
eyelids  carefully.  Use  a  fresh  piece  of  absorbent  cot- 
ton for  each  eye. 

When  the  baby  is  older,  if  the  eyes  are  in  a  healthy 
condition,  it  is  sufficient  to  cleanse  them  daily  with  boiled 
water  and  a  piece  of  old  linen  kept  for  that  purpose, 
tearing  off  a  fresh  piece  every  day. 

Inflammation  of  the  Eyes. — If  the  eyes  become  in- 
flamed, or  if  the  lids  stick  together,  and  any  discharge 
appear,  they  should  be  cleansed  every  hour  with  the 
warm  boric  acid  solution,  and  a  little  vaseline  applied  to 
the  eyelids  at  night.  A  physician  should  be  consulted 
immediately  about  this  condition. 

Precaution. — The  sun  should  never  be  allowed  to 
shine  in  a  baby's  eyes,  and  almost  equally  harmful  is  a 
strong  reflected  light  when  the  sky  is  overcast.  A  para- 
sol with  a  green  lining  is  the  best  protection  against  this. 
Veils  are  undesirable  for  a  baby's  use,  and  may  injure 
the  eyesight. 

CARE  OF  THE  GENITALS 

The  genitals  of  a  baby  should  be  carefully  cleansed 
once  or  twice  a  day  with  boric  acid  solution  (two  tea- 
spoonfuls  to  a  pint  of  warm  water),  by  means  of  a  piece 
of  clean,  absorbent  cotton.     In  the  case  of  boys,  the 


14  HOW  TO  TAKE  CARE  OF  THE  BABY 

foreskin  should  be  gently  pushed  back  every  other  day, 
and  the  parts  underneath  carefully  washed.  If  the  fore- 
skin can  not  be  pushed  back  easily,  no  force  should  be 
used,  but  the  family  physician  should  be  informed  at 
once. 

Any  inflammation  of  these  parts,  or  discharge  from 
them,  should  be  brought  to  the  notice  of  the  family 
physician  without  delay. 

AIRING 

Airing  of  Room. — Fresh  air  is  absolutely  necessary 
to  the  well-being  of  a  baby ;  in  order  that  his  lungs  may 
be  strengthened  and  his  blood  purified,  a  generous  supply 
of  oxygen  is  as  essential  to  his  development  as  his  daily 
food.  He  must,  however,  be  very  gradually  accustomed 
to  this,  and  it  can  best  be  done  at  first  by  airing  the  room 
thoroughly,  at  least  twice  a  day,  and  oftener  if  possible, 
meanwhile  removing  the  baby  to  another  room,  and 
bringing  him  back  only  when  the  room  has  been  re- 
warmed  to  the  proper  temperature. 

Age  and  Seasons  for  Outing. — If  it  is  summertime, 
or  if  living  in  the  South,  the  baby  may  go  out  for  an 
airing  in  his  baby-carriage  when  one  month  old,  provided 
the  sun  is  shining  and  it  is  not  windy  or  damp,  but  in 
winter  in  the  North  it  is  often  not  advisable  to  take  a 
young  baby  out  for  two  months  or  more  after  birth. 

Indoor  Airing. — His  daily  airing,  however,  can  be 
accomplished  in  the  following  manner:  dress  him  ex- 
actly as  if  he  were  going  out,  put  him  in  his  baby-car- 
riage, then  take  him  in  a  room  where  the  windows  are 
all  wide  open  from  the  top,  close  the  doors,  so  that 
there  will  be  no  draft,  and  wheel  him  about  the  room 
for  a  quarter  of  an  hour,  gradually  lengthening  the 
time  to  an  hour  or  two,  morning  and  afternoon.  In  this 
way  his  lungs  become  gradually  accustomed  to  taking  in 


A   MOTHER'S    GUIDE  15 

the  cool  air,  his  color  and  appetite  will  improve,  and  he 
will  be  far  less  likely  to  catch  cold  than  if  forced  to 
breathe  a  furnace-heated  atmosphere  all  day  long. 

General  Rules  for  Outings. — After  a  few  weeks  of 
indoor  airing,  the  child  can  be  taken  out  in  the  open 
on  a  mild,  sunny  day,  but  this  should  not  be  done  under 
the  age  of  four  months  if  the  temperature  is  below 
freezing,  nor  on  days  when  it  is  below  20°  until  he  is 
a  year  old.  In  fine  weather  he  should  be  out  for  four 
or  five  hours  each  day.  In  winter  the  best  hours  for 
his  airing  are  from  10  a.  m.  to  3  p.  m.,  in  spring  and 
autumn  from  9  a.  m.  to  4  p.  m.,  but  in  midsummer,  on 
hot  days,  his  outings  should  be  taken  in  the  early  morn- 
ing, and  in  the  late  afternoon;  he  must,  however,  never 
be  kept  out  after  the  dew  has  begun  to  fall.  In  the  heat 
of  the  day  he  is  better  off  on  a  cool  veranda. 

Sleeping  Out-of-Doors. — Sleeping  out-of-doors  is 
very  beneficial  to  a  baby,  and  he  should  be  trained  to 
have  his  daily  nap  out  in  the  open  whenever  this  is  pos- 
sible, but  care  must  be  taken  to  shield  him  from  strong 
winds,  and  in  summer  he  should  be  protected  by  a  mos- 
quito netting. 

Precautions. — The  only  times  when  it  is  not  ad- 
visable to  send  a  well  baby  over  four  months  old  out 
are  on  foggy  or  very  windy  days,  when  it  is  raining, 
snowing,  or  the  temperature  below  20°,  or  if  it  is  cloudy, 
and  much  melting  snow  on  the  ground.  On  days  like 
these,  the  indoor  airing  can  always  be  substituted;  it 
will  also  be  found  useful  after  an  illness,  when  it  is  not 
advisable  to  take  the  child  out  in  the  open. 

Never  allow  the  light  to  shine  directly  into  a  baby's 
eyes.  A  parasol  lined  with  green  should  always  be  pro- 
vided to  prevent  this,  as  serious  injury  to  the  eyesight 
may  result  from  neglecting  this  precaution. 

Never  send  a  baby  out  with  cold  hands  and  feet,  and 
be  sure  he  is  sufficiently  warm;  but,  on  the  other  hand, 


16  HOW  TO  TAKE  CARE  OF  THE  BABY 

do  not  overwrap  him  and  cause  him  to  perspire,  as  this 
is  the  surest  way  for  him  to  catch  cold. 

Importance  of  Out-of-Door  Air  and  Exercise. — A 
child  over  one  year  old  can  stand  much  cooler  air,  and 
when  old  enough  to  exercise  he  should  be  allowed  to 
run  about  in  almost  any  weather,  properly  protected 
from  the  cold  or  damp,  and  provided  he  is  in  good  health. 
Children  kept  too  closely  housed,  in  overheated  and 
badly  ventilated  rooms,  and  deprived  of,  or  given  insuffi- 
cient outdoor  air  and  exercise,  are  bound  to  suffer  as  a 
result.  They  lose  their  appetite,  become  pale  and  anemic, 
sleep  badly  and  catch  cold  easily. 

EXERCISE 

Exercise  in  Infancy. — In  early  infancy  the  only 
means  a  baby  has  of  taking  exercise  is  by  crying,  kick- 
ing, and  waving  his  arms;  and  he  should  be  allowed  to 
indulge  in  these  exercises,  in  order  to  expand  his  lungs 
and  develop  his  muscles.  A  half  hour's  lusty  crying  in 
the  day  is  actually  beneficial  to  an  infant,  and  after  the 
first  month  he  should  be  allowed  to  kick  on  the  bed  for 
a  few  minutes  two  or  three  times  a  day,  with  his  arms 
and  legs  quite  free.  Even  from  birth  he  should  not  be 
left  to  lie  quiet  for  too  long  a  period  of  time,  but  must 
be  picked  up  and  carried  about  occasionally.  This  is 
especially  true  of  weakly  infants  or  those  suffering  from 
malnutrition  ;  their  position  should  be  frequently  changed, 
and  they  should  be  carried  about  more  often  than  a 
healthy  child,  and  also  rubbed  two  or  three  times  a  day 
with  cocoa  butter.  These  measures  all  help  to  strengthen 
an  infant's  vitality,  and  are  as  necessary  to  his  develop- 
ment as  the  routine  in  regard  to  bathing,  sleeping,  etc. 

Care  in  Lifting. — Great  care  must  be  taken  in  regard 
to  lifting  a  young  baby,  and  he  must  never  be  placed 


A   MOTHER'S  GUIDE  17 

in  an  upright  position  without  proper  support,  as  spinal 
deformities  often  follow  neglect  of  this  precaution. 
When  a  little  older,  babies  are  often  forced  to  stand 
upon  the  lap,  and  if  they  are  then  sufifering  from  rickets, 
any  deformity  of  the  legs,  such  as  bow-legs,  or  knock- 
knees,  may  be  aggravated. 

Walking. — A  child  should  never  be  taught  to  walk; 
he  will  do  so  readily  enough  when  his  legs  are  able  to 
support  him,  and  only  harm  can  come  from  forcing 
him  too  soon. 

Daily  Exercise. — Before  he  walks  he  should  be  put 
on  a  heavy  blanket  or  quilt  in  an  exercise  pen  for  an 
hour  or  so  twice  a  day,  and  allowed  to  kick  and  roll 
about  to  his  heart's  content.  When  he  has  once  learned 
to  walk,  there  will  be  no  difficulty  in  his  getting  sufficient 
exercise  if  he  is  strong  and  healthy,  and  allowed  enough 
freedom  to  do  so.  All  romping  and  violent  exercise 
should  be  confined  to  the  earlier  part  of  the  day,  as  it 
may  prove  harmful  if  indulged  in  just  before  bedtime. 

Older  Children. — As  children  grow  older,  they 
should  play  more  out-of-doors,  and  all  forms  of  exer- 
cise should  be  encouraged,  provided  they  are  never  so 
violent  or  prolonged  as  to  lead  to  exhaustion. 

Indoor  Exercise. — Indoor  exercise  for  older  children 
should  be  confined  as  much  as  possible  to  very  rainy 
weather,  and  the  temperature  of  the  room  regulated  to 
be  not  above  65°  F.  Their  clothing  should  be  loose 
and  light. 

SLEEP 

Sleep  a  Guide  to  Health. — Sleep  in  infancy  is  a  very 
accurate  guide  to  the  child's  physical  condition.  It  should 
be  quiet  and  regular,  and  any  signs  of  prolonged  rest- 
lessness may  be  taken  as  a  symptom  of  some  disorder, 
usually  digestive. 


18  HOW  TO  TAKE  CARE  OF  THE  BABY 

Amount  of  Sleep  During  Infancy. — A  baby's  sleep 
during  the  first  few  days  of  life  should  be  almost  con- 
tinuous, his  only  waking  intervals  being  for  nursing  and 
bathing.  For  the  first  month  he  should  sleep  twenty- 
two  hours  out  of  the  twenty-four ;  after  this,  his  periods 
of  waking  will  be  gradually  lengthened  until  at  six 
months  his  day's  sleep  will  be  arranged  as  follows:  A 
two  hours'  nap  in  the  morning,  and  another  about  the 
same  length  of  time  in  the  afternoon.  At  6  p.  m.  he 
should  be  put  to  sleep  for  the  night,  except  that  at  ten 
o'clock  his  diaper  should  be  changed,  and  his  night  feed- 
ing given,  but  without  disturbing  him  in  the  crib.  If  he 
is  quite  well,  and  has  not  developed  any  bad  habits,  he 
will  fall  asleep  immediately  after  this,  and  should  not 
wake  until  six  the  next  morning. 

Sleep  After  Two  Years. — At  about  two  years  of  age 
a  child  should  learn  to  sleep  from  6  p.  m.  to  6  a.  m. 
without  feeding.  This  twelve  hours'  rest  at  night  should 
be  continued  up  to  six  years  of  age. 

Day-Naps. — From  the  eighteenth  month,  one  of  the 
day-naps  may  be  discontinued,  but  the  child  should  be 
encouraged  to  take  one  nap  a  day  for  as  long  a  time  as 
he  will,  up  to  four  years  of  age,  or  longer. 

Position  of  Child  During  Sleep. — It  is  important  to 
turn  a  young  infant  from  time  to  time,  for  if  he  is  al- 
lowed to  sleep  too  much  on  one  side,  it  is  liable  to  cause 
deformity  of  the  head.  He  should  never  be  placed  on 
his  back  to  sleep,  and  even  when  awake,  only  when  the 
mother  or  nurse  is  constantly  present,  for  if  an  attack 
of  vomiting  were  to  occur  he  would  be  very  likely  to 
get  food  into  his  windpipe. 

Directions  for  Children's  Sleep. — A  baby  must  sleep 
alone  from  the  first ;  lying  with  the  mother  is  very  apt 
to  lead  to  irregularities  in  nursing,  etc.,  and  there  is 
also  the  danger  of  overlying.  Older  children  should 
have  separate  beds,  thereby  minimizing  the  chances  of 


A   MOTHER'S   GUIDE  19 

any  infection,  and  also  insuring  a  good  night's  sleep  for 
one  child  in  the  event  of  the  other  one  being  restless  or  ill. 

How  to  Prepare  a  Baby  for  Sleep. — The  baby  should 
be  undressed  and  prepared  for  bed,  and  the  diaper 
changed  before  giving  the  bottle ;  he  should  be  laid  down 
immediately  after  feeding  while  he  is  still  awake,  the 
room  darkened  and  the  window  opened.  He  must  learn 
to  go  to  sleep  by  himself,  and  all  habits  such  as  rocking 
or  patting,  or  the  giving  of  a  pacifier  or  finger  to  suck, 
ought  never  to  be  allowed,  as  they  will  only  lead  to 
more  trouble  in  the  end.  If  he  is  restless  and  refuses 
to  sleep  there  is  some  good  reason  for  it,  and  this  must 
be  found  and  remedied,  as  nothing  else  will  produce  any 
lasting  results,  but  will  only  lead  to  bad  habits  in  addi- 
tion. Soothing  sirups  and  drugs  must  never  be  admin- 
istered under  any  circumstances  by  a  mother  or  nurse; 
if  a  drug  is  given,  it  must  be  on  the  advice  of  a  physi- 
cian. 

How  to  Treat  a  Crying  Baby. — A  baby  may  cry  for 
a  few  minutes  before  going  to  sleep ;  this  is  exercise  for 
his  lungs,  and  unless  it  is  prolonged  no  notice  should  be 
taken  of  it.  It  is  also  a  mistake  to  pick  up  a  baby  im- 
mediately if  he  wakes  and  cries  at  night,  for  if  left  alone, 
he  will  often  go  to  sleep  again.  If  he  does  not,  and  be- 
fore taking  him  out  of  bed,  try  turning  him  over.  This 
may  accomplish  the  desired  result. 

Quiet. — While  the  baby's  room  should  not  be  noisy, 
it  will  never  be  necessary  to  whisper  or  make  any  un- 
usual efforts  at  quietness ;  if  he  has  been  accustomed 
from  the  first  to  the  ordinary  household  sounds,  he  will 
not  notice  any  noises,  unless  they  are  yery  sudden,  shrill, 
or  unusual. 

Sleeplessness  and  Its  Common  Causes. — If,  how- 
ever, a  baby  awakes  often  and  is  restless,  or  stays  awak^ 
a  long  time,  it  will  probably  be  due  to  one  or  another  of 
the  following  causes : 


20  HOW  TO  TAKE  CARE  OF  THE  BABX 

1.  In  a  nursing  baby,  frequently  hunger, 

2.  Thirst. 

3.  Cold  feet  or  wet  diaper. 

4.  Insufficient  or  too  much  clothing. 

5.  Derangement  of  digestion,  due  to  improper  food, 
or  irregular  feeding,  over-feeding,  or  too  much  night 
feeding. 

6.  Bad  or  irregular  habits. 

7.  Bad  air  and  insufficient  ventilation. 

8.  Dentition. 

9.  Excitement  or  nervous  fears,  sometimes  induced 
by  romping  and  playing  with  a  child  just  before  bed- 
time. 

Other  Reasons. — These  are  the  most  common  causes 
of  insomnia  in  infancy,  but  other  reasons  may  also  exist, 
such  as  anemia  or  malnutrition ;  imperfect  breathing 
due  to  adenoids  or  tonsils,  or  the  earliest  symptoms  of 
hip-disease  or  some  other  illness.  In  dealing  with  any 
of  these  conditions,  it  is  imperative  to  consult  a  physi- 
cian. 

Treatment. — Having  investigated  and  corrected 
any  mistakes  in  feeding  or  habits  of  a  baby  suffering 
from  sleeplessness,  whatever  the  cause  may  have  been, 
the  following  routine  should  be  observed:  A  simple 
diet  at  regular  intervals,  no  eating  or  drinking  at  night 
except  water,  no  excitement,  plenty  of  fresh  air  in  the 
daytime,  and  at  night  a  quiet,  dark  and  airy  room.  A 
warm  bath  before  going  to  bed  will  often  be  found  bene- 
ficial, and  in  the  case  of  older  children,  the  reduction 
of  foods  that  induce  flatulence,  such  as  sugar,  starch,  etc. 

A  Nervous  Child. — A  delicate,  nervous  child  is  often 
a  bad  sleeper,  and  in  this  case  the  same  rules  are  to  be 
followed,  particular  attention  being  paid  to  keeping  him 
from  any  excitement;  if  the  child  is  older,  no  study 
should  be  allowed  for  a  time,  but  instead,  plenty  of  ex- 


A   MOTHER'S   GUIDE  21 

ercise  in  the  fresh  air.  If  this  routine  is  rigidly  fol- 
lowed, there  is  no  reason  why  the  condition  should  not 
be  overcome  even  if  the  nervousness  is  hereditary. 

Habit  of  Sleep. — Children  do  not  sleep  to  excess 
unless  some  drug  has  been  administered,  or  unless  they 
are  sick.  In  health,  sleep  is  largely  a  matter  of  habit, 
and  it  sometimes  happens  that  a  baby  develops  the  bad 
habit  of  sleeping  longer  in  the  daytime,  and  staying 
awake  at  night.  If  this  is  not  due  to  any  other  condi- 
tion, it  is  easily  remedied  by  forcing  him  to  remain 
awake  longer  in  the  day,  he  will  then  become  tired,  and 
is  more  likely  to  sleep  at  night. 

Sleep  of  Early  Infancy. — Although  a  young  infant's 
sleep  should  be  quiet,  it  is  not  very  deep,  and  it  is  not 
until  about  three  years  of  age  that  a  child  sleeps  heavily. 

NURSING 

It  is  undoubtedly  the  duty  of  every  mother  to  nurse 
her  baby,  and  regard  for  his  welfare  should  induce  her 
to  attempt  it  even  if  the  chances  of  success  seem  small, 
except  in  the  following  conditions  rendering  it  an  im- 
possibility, such  as : 

Conditions  Making  Nursing  Impossible. — A  defect 
in  the  nipples  or  the  absence  of  milk.  An  infant  unable 
to  suck  properly,  owing  to  his  being  very  weak,  or  tongue- 
tied,  or  having  a  cleft  palate.  (In  the  last  case,  the  milk 
comes  out  through  nostrils.) 

Conditions  Prohibiting  Nursing. — In  addition  to 
these,  are  certain  conditions  of  the  mother  when  nursing 
should  be  absolutely  forbidden.     These  are  as  follows: 

1.  When  the  mother  is  suffering  from  tuberculosis 
in  any  form. 

2.  When  she  has  a  serious  disease  of  the  heart  or  kid- 
neys. 


22  HOW  TO  TAKE  CARE  OF  THE  BABY 

3.  When  she  is  suffering  from  any  infectious  or  con- 
tagious disease,  such  as  diphtheria,  pneumonia,  whoop- 
ing cough,  etc. 

4.  When  she  is  epileptic  or  choreic. 

5.  When  she  is  losing  flesh  and  strength,  and  is  much 
debilitated. 

When  a  mother  has  recovered  from  a  short  illness, 
during  which  she  has  not  nursed  her  baby,  and  finds 
that  she  has  still  some  milk  in  her  breasts,  she  should 
resume  nursing.  Sometimes  the  milk  returns  as  abun- 
dantly as  before  the  sickness. 

Successful  Nursing. — A  great  deal  will  depend  upon 
the  care  of  the  breasts  and  nipples,  and  the  regulation 
of  the  mother's  diet  and  habits.  The  following  simple 
rules  must  be  adhered  to  if  success  is  to  follow: 

Care  of  the  Nipples  and  Breasts. — A  day  before  the 
arrival  of  the  infant  the  nipples  should  be  carefully 
washed  with  soap  and  water  and  a  soft  brush  used  to 
keep  the  openings  in  the  nipples  clear.  Before  and  after 
nursing,  the  nipples  must  be  washed  with  a  solution  of 
boric  acid  and  carefully  dried. 

It  is  very  important  to  prevent  sore  nipples,  and  if 
they  are  at  all  tender  after  nursing,  the  washing  with 
boric  acid  should  be  followed  by  sponging  with  alcohol, 
and  then  drying.  Applications  of  zinc  oxide  ointment  or 
boric  acid  ointment  are  very  healing.  A  nipple  shield 
may  be  used,  but  most  infants  refuse  to  nurse  from  them. 
The  breast  must  be  squeezed  so  as  to  fill  the  nipple  be- 
fore putting  the  baby  to  it. 

If  the  nipples  are  very  sore  and  bleeding,  it  is  some- 
times necessary  to  keep  the  baby  from  nursing  for  a 
day  or  two.  The  breasts  ought  then  to  be  massaged 
with  sweet  oil,  first  washing  hands  and  breasts  with 
soap  and  water.  The  breasts  should  be  massaged  all 
the  way  around  with  firm  pressure,  starting  from  the 


A  MOTHER'S   GUIDE  23 

base,  and  ending  up  at  the  nipple.  Afterward  a  breast 
pump  must  be  used  to  draw  off  the  milk. 

When  they  are  healed,  the  baby  should  be  put  to  the 
breast  only  every  other  nursing  for  a  day  or  so.  If  the 
milk  is  abundant,  pump  and  keep  it  in  a  bottle,  using  it 
for  the  intermediate  feedings. 

Large  pendulous  breasts  should  be  supported  at  first 
by  bandages,  and  later  by  loose  corsets.  If  the  milk 
seems  slow  in  coming  or  is  scanty,  the  breasts  may  be 
massaged  for  five  or  ten  minutes  two  or  three  times  a 
day  to  increase  the  flow. 

Rules  for  a  Nursing  Mother's  Guidance. — 1.  A 
nursing  mother  should  lead  a  simple,  regular  life,  on  a 
diet  to  which  she  has  been  accustomed,  but  avoiding  too 
much  meat,  strong  coffee,  pastry,  candy,  spices,  or  highly 
seasoned  dishes.  Plain,  well-cooked  food  should  be  given 
her,  with  plenty  of  milk  and  no  alcoholic  beverages,  ex- 
cept when  prescribed  by  a  physician.  She  needs  the 
mineral  salts  of  vegetables;  she  should  therefore  have 
the  purees  of  a  mixture  of  vegetables.  None  of  the 
water  in  which  these  vegetables  are  cooked  should  be 
thrown  away.    Only  whole  wheat  bread  should  be  eaten. 

2.  She  needs  plenty  of  sleep,  at  least  eight  hours,  and 
if  she  has  had  a  bad  night,  she  should  take  a  nap  in  the 
daytime. 

3.  She  must  have  regular  exercise,  at  least  one  hour's 
walk  morning  and  evening,  but  she  ought  never  to  tire 
herself  to  the  point  of  exhaustion. 

4.  She  must  avoid  late  hours,  worry  and  excitement, 
as  the  effect  of  these  is  most  detrimental  to  the  milk. 

5.  She  should  keep  her  bowels  regular  by  means  of 
proper  diet  and  exercise,  and,  if  necessary,  by  a  mild 
cathartic,  such  as  Cascara,  Citrate  of  Magnesia,  Ro- 
chelle  Salts,  Glauber's  Salts,  etc.,  but  this  should  not  be 
continued  indefinitely.    Two  or  more  bran  biscuits  (see 


24  HOW  TO  TAKE  CARE  OF  THE  BABY 

food  recipes)  a  day  included  in  her  diet  will  help  in 
keeping  her  bowels  regular.  If  the  constipation  becomes 
chronic,  however,  she  should  consult  a  physician. 

6.  A  nursing  mother  often  becomes  anemic,  with 
the  result  that  her  milk  is  deficient  in  iron,  thereby  caus- 
ing the  child  to  become  anemic  also.  It  is  a  good  plan, 
therefore,  when  in  this  condition,  to  apply  to  her  physi- 
cian for  an  iron  tonic. 

7.  With  the  above  exceptions  she  should  take  no 
drugs  or  medicines  unless  they  are  ordered  by  the  physi- 
cian. 

Schedule  for  Nursing. — The  infant  should  be  put 
to  the  breast  five  or  six  hours  after  birth,  and  then  every 
four  hours  for  the  next  two  days;  after  that  according 
to  the  following  schedule : 


1st  &  2nd  day 

1st  &  2nd  months 

3rd,  4th  &  5th  months 

After 

Every 

Every 

Every 

5  months 

4  hours 

214  hours 

3  hours 

Every  3  hrs. 

4  a.  m. 

6       a.  m. 

6  a.  m. 

6  a.  m. 

8  a.  m. 

8 :30  a.  m. 

9  a.  m. 

9  a.  m. 

12  p.  m. 

11        a.m. 

12  a.  m. 

12  p.  m. 

4  p.  m. 

1:30  p.m. 

3  p.m. 

3  p.  m. 

8  p.m. 

4       p.  m. 

6  p.m. 

6  p.  m. 

6 :30  p.  m. 

10  p.m. 

10  p.m. 

10       p.  m. 

2  a.  m. 

2       a.  m. 

As  mother's  milk  takes  nearly  two  hours  to  be  com- 
pletely digested,  and  as  a  baby  usually  nurses  about  fif- 
teen or  twenty  minutes,  the  intervals  between  nursings 
should  not  be  less  than  two  and  a  half  hours.  I  have 
found  by  experience  that  the  feeding  at  10  p.  m.  instead 
of  9  p.  m.  is  much  more  satisfactory,  and  the  child  is 
more  likely  to  sleep  longer  and  better. 

The  milk  in  the  breast  does  not  secrete  in  sufficient 


A   MOTHER'S   GUIDE  25 

amount  until  the  third  or  fourth  day,  and  sometimes 
later. 

Regular  Nursing  Habits. — Regular  habits  in  nurs- 
ing should  begin  from  the  first,  and  strict  attention  to 
this  matter  is  most  important.  The  baby  must  never  be 
allowed  to  nurse  longer  than  twenty  minutes,  and  should 
be  given  one  breast  at  one  feeding  and  the  other  breast 
at  the  next,  unless  he  is  older  and  requires  more,  when 
he  may  be  allowed  to  nurse  ten  minutes  at  each  breast 
for  every  feeding. 

The  First  Day. — The  baby  requires  no  other  food 
on  the  first  day,  except  a  little  warm  water  with  milk- 
sugar,  one-half  ounce  sugar  to  ten  ounces  water ;  of  this 
he  may  have  from  four  to  eight  teaspoonfuls,  between 
nursings.  Do  not  give  the  baby  any  castor  oil  or  any  in- 
jection to  make  the  bowels  move.  It  is  quite  unnecessary 
and  may  be  harmful.  Some  nurses  give  injections  with  the 
object  of  getting  rid  of  the  meconium  or  black  tarry  mat- 
ter in  the  bowels.  Nature  never  intended  babies  to  be  in- 
terfered with  in  the  first  few  days  of  their  lives.  The 
meconium  is  a  natural  lubricant  for  the  bowels  and 
should  not  be  forcibly  removed. 

Training  the  Baby. — He  should  be  awakened  in  the 
daytime  to  nurse,  but  allowed  to  sleep  after  10  p.  m.  In 
this  way  an  infant  will  soon  be  trained  to  sleep  all  night, 
and  at  the  age  of  five  months  a  healthy  baby  will  re- 
quire no  nursing  between  10  p.  m.  and  6  a.  m.  This 
can  be  easily  accomplished  by  never  deviating  from  the 
regular  feeding  schedule,  and  will  be  of  great  benefit 
to  both  mother  and  child.  Infants  can  often  be  trained 
at  an  earlier  age  to  sleep  all  night  without  nursing. 

Mixed  Feeding. — It  is  advisable  to  begin  giving  a 
baby  one  bottle  in  the  twenty-four  hours  from  the  time 
he  is  one  or  two  weeks  old,  beginning  with  formula  No. 
2  and  gradually  increasing  the  amount  so  as  to  be  suit- 
able for  his  age.    The  reasons  for  this  are  various.    The 


26  HOW  TO  TAKE  CARE  OF  THE  BABY 

mother  may  be  suddenly  taken  ill,  or  unavoidably  ab- 
sent, or  her  milk  may  be  temporarily  unfit  for  the  baby's 
use,  as  a  result  of  violent  emotion,  menstruation,  etc. 
As  a  precaution,  therefore,  against  any  of  these  even- 
tualities, it  is  wise  to  accustom  the  baby  at  an  early  age 
to  taking  the  bottle,  for  it  is  much  more  difficult  to  get 
him  to  do  so  when  he  is  older.  It  also  makes  it  much 
easier  later  to  wean  him. 

When  Milk  Does  Not  Agree. — It  may  sometimes 
happen  that  the  mother's  milk  does  not  agree  with  an 
infant,  but  she  should  not  for  that  reason  give  up  nurs- 
ing until  every  effort  has  been  made  to  discover  the 
cause,  and,  if  possible,  to  rectify  it.  If  the  infant  shows 
symptoms  of  indigestion,  viz.,  vomiting,  colic,  diarrhea, 
or  constipation,  it  is  necessary  to  find  out  to  which  of 
the  following  conditions  this  is  due : 

1.  The  child  takes  too  much  at  each  nursing. 

2.  The  child  takes  the  milk  too  quickly. 

3.  The  milk  is  too  rich, 

4.  The  milk  is  scanty. 

5.  The  milk  is  too  poor. 

More  than  one  of  these  conditions  may  exist  at  the 
same  time. 

The  First  Two  Conditions. — The  first  two  condi- 
tions may  be  ascertained  by  carefully  weighing  the  baby 
before  and  after  nursing.  The  child  need  not  be  un- 
dressed for  this  purpose,  and  the  scales  must  be  ac- 
curate. Now  suppose  an  infant  one  month  old,  that  is 
not  thriving  and  weighs  only  six  pounds  and  eight  ounces, 
weighs  four  or  five  ounces  more  after  nursing  for 
twenty  minutes,  we  then  know  that  it  has  taken  too 
much  and  that  being  under  weight  it  should  not  have  had 
more  than  two  and  a  half  ounces  or  three  ounces.  At 
the  next  hour  for  nursing,  we  weigh  the  baby,  allow 
it  to  nurse  two  minutes  at  one  breast,  and  then  weigh 
it  again.    After  that  we  give  it  the  other  breast,  weigh 


A   MOTHER'S   GUIDE  27 

it  once  more,  and  in  this  way  we  ascertain  not  only 
how  much  the  child  has  taken,  but  how  quickly.  If 
the  amount  is  too  large  we  shorten  the  time  of  nurs- 
ing at  each  breast  to  five,  six  or  seven  minutes,  de- 
pending upon  the  amount  taken,  or  give  it  only  one 
breast  at  a  nursing,  and  weigh  the  child  before  and 
after  feeding  until  we  have  regulated  it  to  the  requisite 
amount.  Some  infants  can  take  at  the  rate  of  as  much 
as  one  ounce  of  milk  a  minute  during  the  first  few 
minutes,  and  thus  not  only  overload  their  little  stomachs 
but  also  nurse  too  quickly. 

Signs  of  Too  Much  Milk. — Symptoms  in  a  nursing 
baby  taking  too  much  milk : 

a.  Shows  rapid  gain  in  weight. 

b.  Seems  overfed  after  nursing. 

c.  Vomits  after  meals. 

d.  Has  wind  and  colic. 

e.  Perspires  on  head  and  neck. 

f.  Is  drowsy  and  heavy,  and  sleeps  a  great  deal,  but 
may  be  restless  from  colic  and  wind. 

g.  Passes  much  urine,  diapers  are  always  wet. 
h.    Has  frequent  large  stools. 

One  or  more  of  these  symptoms  may  be  present. 

Too  Quick  Nursing. — If  the  trouble  is  due  to  too 
quick  nursing,  the  child  can  be  put  to  the  breast  for  two 
minutes  at  a  time  with  intervals  of  one  or  two  minutes, 
or  the  mother  can  compress  the  base  of  the  nipple  be- 
tween the  first  and  second  fingers  while  the  child  is  nurs- 
ing. The  latter  method  will  be  found  easier  for  both 
mother  and  child.  If  this  does  not  succeed,  nurse  less 
and  give  one  or  two  ounces  of  water  before  nursing. 

Too  Rich  Milk. — In  the  condition  under  heading 
No.  3  above,  the  infant  will  often  show  symptoms,  such 
as  vomiting,  colic,  green  stools,  diarrhea  or  constipa- 
tion, restlessness,  sleeplessness,  etc. 

The  milk  is  made  too  rich  by : 


28  HOW  TO  TAKE  CARE  OF  THE  BABY, 

1.  Too  rich  foods. 

2.  Too  little  or  too  much  exercise,  fatigue  or  want  of 
sleep. 

3.  Mental  excitement,  social  engagements,  etc. 

4.  Emotional  disturbances,  grief,  temper,  etc. 

5.  The  onset  of  menstruation. 

Having  previously  ascertained  that  the  child  is  not 
taking  too  much,  nor  feeding  too  rapidly,  we  can  be 
reasonably  certain  that  the  milk  is  too  rich.  We  there- 
fore proceed  as  follows : 

Treatment. — The  infant  should  be  given,  before  each 
nursing,  an  ounce  of  warm  water  which  has  been  previ- 
ously boiled,  and,  if  necessary,  slightly  sweetened  with 
one-fourth  teaspoonful  of  milk  sugar.  This  can  be  given 
from  a  regular  feeding  bottle  and  gradually  discontinued 
as  the  child  improves.  Lengthening  the  intervals  be- 
tween the  feedings  to  at  least  three  hours  also  tends  to 
make  the  milk  poorer  in  quality.  The  first  few  ounces 
taken  from  the  breast  are  not  so  rich  as  the  last  ones, 
therefore  the  child  should  not  be  allowed  to  drain  the 
breasts,  and  must  not  nurse  so  long  as  he  has  been  ac- 
customed to  doing,  but  should  nurse  from  both  breasts. 
The  ounce  of  warm  water  which  he  receives  before 
nursing  dilutes  the  milk,  and  at  the  same  time  brings 
the  quantity  up  to  the  requisite  amount. 

Rich  milk  is  very  often  the  result  of  the  mother's 
mode  of  living,  and  neglect  of  the  rules  for  diet,  exer- 
cise, etc.,  which  have  already  been  enumerated.  An 
improvement  in  the  milk  will  often  follow  strict  atten- 
tion to  these  matters,  particularly  by  reducing  the  amount 
of  meat,  and  prohibiting  alcohol  in  any  form ;  also  re- 
quiring the  mother  to  take  daily  exercise  in  the  open 
air.  It  sometimes  happens  that  the  mother's  first  men- 
struation period,  and  perhaps  subsequent  ones,  will  be 
responsible  for  indigestion  in  the  infant ;  when  this  hap- 


A   MOTHER'S   GUIDE  29 

pens,  it  is  usually  better  to  give  the  bottle  at  alternate 
feedings  during  the  time  of  menstruation. 

If  the  child's  symptoms  do  not  improve  after  diluting 
the  breast-milk  by  giving  water  before  nursing,  length- 
ening the  intervals  between  nursings  to  three  hours, 
shortening  the  time  of  nursing,  and  careful  regulation 
of  the  mother's  diet,  and  the  child  is  steadily  losing 
weight,  it  will  then  be  necessary  to  put  him  on  the  bot- 
tle, pumping  the  breasts  meanwhile.  When  he  shows 
signs  of  improvement,  two  or  three  days  after,  he  can 
be  gradually  brought  back  again  to  the  breast.  If  this 
is  followed  a  second  time  by  an  attack  of  indigestion, 
he  should  be  weaned,  and  it  is  imperative  to  do  this  be- 
fore the  child's  digestion  becomes  too  much  weakened. 

Scanty  Milk. — Symptoms  in  a  nursing  baby  which 
does  not  get  enough  milk: 

1.  It  is  not  satisfied  after  nursing,  and  is  hungry  long 
before  the  next  nursing. 

2.  Does  not  vomit  nor  sufifer  from  colic. 

3.  Is  fretful  and  impatient  while  nursing. 

4.  Little  gain  in  weight. 

5.  Does  not  sleep  enough  and  is  restless. 

6.  Passes  little  urine,  and  the  diaper  may  be  stained 
yellow  or  brick  red.  This  does  not  occur  if  the  child  is 
given  water  to  drink  several  times  a  day  between  nurs- 
ings. 

7.  Is  very  constipated. 

It  is  easy  to  determine  when  the  milk  is  scanty  by 
weighing  the  child  before  and  after  nursing.  When 
this  is  the  case,  the  mother  should  be  given  an  abundant 
diet,  with  plenty  of  meat  and  milk. 

A  mother  who  has  not  enough  milk  should  not  on 
that  account  be  overfed.  A  mother  with  her  first  child 
often  does  not  secrete  much  milk  in  the  first  few  weeks. 
She  should  be  encouraged  and  given  hope  and  confi- 


30  HOW  TO  TAKE  CARE  OF  THE  BABY 

dence  that  plenty  of  milk  will  soon  appear.  In  the 
meantime,  the  infant  should  be  bottle  fed,  after  being 
regularly  put  to  each  breast  for  a  few  minutes.  A  bowl 
of  corn  meal  mush  (see  recipes)  taken  at  night  will 
greatly  help  to  increase  the  supply  of  milk.  Malt  tonics 
are  also  to  be  recommended. 

The  breasts  must  be  gently  massaged  two  or  three 
times  daily  to  stimulate  secretion,  and  every  means  taken 
to  improve  the  mother's  general  condition.  In  this  case, 
the  chances  of  success  depend  entirely  on  the  improve- 
ment of  the  mother. 

In  order  that  the  baby  may  not  lose  weight  in  the 
meantime,  he  should  be  weighed  before  and  after  the 
nursing  in  order  to  ascertain  how  much  short  of  the 
correct  amount  he  is  getting,  and  a  bottle  containing  as 
many  ounces  of  modified  milk  as  are  lacking  in  the 
supply  of  breast-milk  must  be  given  him.  For  instance, 
if  a  normal  child  of  four  months,  weighing  about  thirteen 
and  a  half  pounds  gets  only  two  ounces  from  the  breast 
where  he  should  receive  five  ounces,  we  then  give  three 
ounces  of  modified  milk,  which  must  be  suited  to  his  age 
and  digestive  capacity.  If  he  has  already  been  accustomed 
to  receiving  one  bottle  a  day,  he  will  be  given  his  supple- 
mentary feedings  of  the  same  formula.  If  not,  he  must 
have  a  very  much  weaker  formula,  as  No.  5  or  6,  instead 
of  No.  9,  the  usual  formula  at  that  age. 

Poor  But  Abundant  Milk. — When  the  milk  is  poor 
in  quality,  but  abundant  in  amount,  this  is  shown  by  the 
child's  not  gaining  in  weight,  although  the  weighing  be- 
fore and  after  feeding  shows  he  has  had  a  sufficient 
quantity.  He  will  be  restless,  probably  constipated,  but 
will  not  vomit  nor  show  any  intestinal  symptoms.  This 
is  the  condition  with  the  least  favorable  outlook  for  the 
continuance  of  nursing.  The  mother's  diet  must  be  made 
more  nourishing,   with  plenty  of  milk,  cereals,  meat, 


A   MOTHER'S   GUIDE  31 

poultry,  fish,  etc.,  but  if  conditions  do  not  improve,  the 
child  may  have  to  be  weaned. 

Nursing  mothers  should  not  hastily  conclude  that  their 
milk  does  not  agree,  for  faulty  conditions  are  very  often 
remedied,  and  the  nursing  continued  satisfactorily,  and 
to  the  great  benefit  of  the  child.  On  the  other  hand, 
when  an  infant  continues  with  bad  symptoms  in  spite  of 
all  care,  he  should  be  put  on  artificial  food  alone  for  a 
few  days,  and  if  this  agrees  with  him,  and  with  the  ap- 
proval of  a  physician,  weaned  at  once.  In  this  case,  it 
would  be  a  great  mistake  to  carry  on  a  mixed  feeding: 
viz.,  half  breast  fed  and  half  bottle  fed,  for  we  have 
already  proved  that  the  breast-milk  does  not  agree,  and 
a  continuance  of  it  can  only  lead  to  further  disturbance. 

Mixed  Feeding. — It  is  sometimes  advisable  to  carry 
on  mixed  feeding,  i.  e.,  alternate  nursings  and  feedings, 
from  the  beginning,  in  cases  where  the  mother's  milk 
is  insufficient,  but  does  not  disagree.  It  would  be  wrong 
to  deprive  the  child  entirely  of  the  breast-milk,  although 
it  is  obviously  necessary  to  supplement  it  with  the  bottle. 

Formula  for  Bottle  in  Mixed  Feeding. — When  one 
bottle  in  twenty-four  hours  is  given  at  the  age  of  two 
weeks  for  the  purpose  of  accustoming  the  child  to  the 
bottle.  Formula  No.  2  (see  page  54)  should  be  used,  but 
as  it  is  not  necessary  to  make  so  large  an  amount,  a  ten- 
ounce  mixture,  composed  of  half  the  amounts  mentioned, 
will  be  sufficient.  It  is  not  desirable  to  make  up  less 
than  this,  as  the  quantities  can  not  be  so  accurately 
measured.  Of  this,  two  and  a  half  to  three  and  a  half 
ounces  should  be  given  once  a  day.  If  necessary  to  give 
more  than  one  bottle,  owing  to  the  mother's  illness,  ab- 
sence or  any  other  reason,  the  same  formula  must  be 
used;  but  in  any  case,  if  the  child  makes  a  satisfac- 
tory progress,  after  a  few  days  the  formula  should 
be  changed  to  the  next  stronger  one,  thus  very  grad- 


32  HOW  TO  TAKE  CARE  OF  THE  BABY 

ually  increasing  first  the  quantity  and  then  the  quahty 
of  the  daily  bottle  until  at  six  months  the  child  takes 
six  ounces  of  Formula  No.  11.  At  this  age  he  should 
be  given  two  bottles  a  day,  morning  and  evening, 
these  being  carefully  regulated  according  to  the  child's 
age,  v^eight  and  condition.  The  food  must  be  increased 
until  at  nine  months  of  age  he  gets  two  bottles  of 
Formula  No.  13  or  13^^,  about  eight  ounces  to  each 
feeding,  alternating  with  three  nursings,  at  four-hour 
intervals.  At  about  the  tenth  or  eleventh  month  weaning 
should  begin,  and  breast-feeding  ought  never  to  be  con- 
tinued after  the  twelfth  month,  unless  specially  ordered 
by  a  physician. 

WET-NURSING 

Difficulties. — ^There  are  so  many  difficulties  in  the 
way  of  obtaining  a  good  wet-nurse,  and  her  advent  in 
a  household  is  generally  followed  by  such  disagreeable 
consequences  that  she  is  usually  only  resorted  to  in  very 
extreme  cases,  i.  e.,  when  a  baby's  life  is  in  danger,  and 
all  other  methods  of  feeding  have  failed.  It  must  be 
remembered  that  a  baby  who  has  not  nursed  more  than 
a  few  days  will  rarely  take  the  breast  when  more  than 
three  months  old.    But  it  is  well  worth  trying. 

Cases  Where  Service  of  Wet-Nurse  Is  Indicated. — 
Too  much  time  should  not  be  lost,  however,  before  pro- 
curing a  wet-nurse,  if  the  case  is  urgent,  lest  even  her 
services  may  fail  to  be  of  any  use.  It  is  advisable  to 
secure  one  in  the  case  of  a  premature  baby  under  five 
pounds,  when  the  mother  is  unable  to  nurse  him,  or  for 
any  baby  under  six  months  of  age  who  is  suffering  from 
chronic  indigestion,  inanition,  and  continuous  loss  of 
weight.  For  these,  wet-nursing  is  often  the  only  means 
of  salvation,  and  is  frequently  followed  by  rapid  gain 
in  weight,  when  every  other  method  of  feeding  has  been 
attended  by  steady  loss. 


A   MOTHER'S   GUIDE  33 

Selection  of  a  Wet-Nurse. — In  selecting  a  wet-nurse, 
the  importance  of  a  thorough  physical  examination  of 
both  the  mother  and  her  child  by  a  physician  is  of  the 
greatest  importance.  She  must  be  in  good  health  and 
free  from  tuberculosis,  syphilis,  or  any  skin  disease,  and 
her  teeth  and  hair  must  be  carefully  inspected.  The 
size  of  her  breasts  are  by  no  means  an  infallible  guide, 
for  large  breasts  do  not  always  mean  an  abundant  supply 
of  milk,  and  sometimes  smaller  breasts  will  have  more 
milk.  The  only  way  of  correctly  estimating  a  woman's 
supply  of  milk,  is  by  weighing  her  own  baby  before  and 
after  nursing. 

If  possible,  a  woman  between  the  ages  of  twenty  and 
thirty  should  be  chosen,  and  one  with  her  first  baby. 
It  is  not  necessary  for  her  own  infant  to  be  the  same 
age  as  the  foster  child,  as  the  changes  in  the  milk  after 
the  first  month  are  very  slight.  It  is  not  safe  to  take  a 
woman  whose  baby  is  under  two  or  three  months  old, 
for  if  the  mother  has  any  syphilitic  taint,  it  will  often 
never  be  visible  in  herself,  but  her  child  will  develop  it 
during  the  first  two  or  three  months  of  its  existence; 
therefore,  until  that  age  is  passed,  we  can  not  be  sure 
of  the  mother's  fitness  in  that  respect.  It  is  the  condi- 
tion of  her  own  baby  that  is  a  woman's  best  recommenda- 
tion for  the  position,  and  it  is  never  safe  to  engage  one 
whose  baby  has  died,  unless  on  the  special  recommenda- 
tion of  a  physician  who  has  had  both  mother  and  child 
under  his  care. 

Even  when  all  things  seem  favorable,  it  is  always  an 
experiment,  for  what  suits  one  baby  may  not  suit  an- 
other. 

Dilution  of  Milk. — For  a  premature  baby  or  one 
under  one  month  old,  provided  it  can  take  the  breast 
properly,  the  breast  milk  should  be  diluted  at  first  by 
giving  the  child  from  two  to  four  teaspoon fuls  of  water 
before  nursing. 


34  HOW  TO  TAKE  CARE  OF  THE  BABY 

If  the  baby  is  unable  to  suckle  properly,  the  milk  must 
be  pumped,  and  then  diluted  with  an  equal  amount  of 
water  before  offering  it  to  the  child.  While  the  milk 
is  being  pumped,  the  woman  should  be  allowed  to  nurse 
her  own  baby,  otherwise  the  milk  is  liable  to  dry  up. 

Cases  Where  Pumping  the  Milk  Is  Necessary. — 
Sometimes  a  baby  who  has  been  accustomed  to  the  bot- 
tle will  refuse  to  nurse,  and  in  this  case  also  pumping 
has  to  be  resorted  to,  and  the  milk  given  from  the  bottle. 
If  this  is  kept  up  for  two  or  three  weeks  only,  with  a 
baby  suft'ering  from  acute  inanition,  it  may  be  sufficient 
to  start  him  on  the  right  road. 

When  a  wet-nurse  is  not  obtainable,  some  reputable 
nursing-woman  in  the  neighborhood  may  be  induced 
to  pump  some  of  her  milk  once  or  twice  a  day.  This 
milk  given  at  two  feedings  for  a  short  time  will  often 
be  the  means  of  bringing  about  a  favorable  turn  in  the 
child's  condition. 

Pump  Recommended. — The  English  breast-pump 
is  generally  used.  A  simpler  and  more  effective  pump 
can  be  improvised  as  follows:  select  a  baby's  bottle,  or 
any  other  bottle,  the  mouth  of  which  fits  easily  over  the 
mother's  nipple.  Place  the  bottle  in  boiling  water  for  a 
minute,  then  remove  it  and  dry  it  rapidly  by  holding  it 
in  a  towel  and  shaking  out  all  the  water.  With  a  cold 
wet  cloth  cool  off  the  mouth  of  the  bottle,  then  place  it 
firmly  over  the  nipple.  As  soon  as  the  bottle  begins  to 
cool,  the  milk  will  flow  into  it. 

Treatment  of  a  Wet-Nurse. — The  failure  of  wet- 
nurses  is  often  due  to  their  being  overfed,  and  given  a 
variety  of  rich,  highly  seasoned  dishes  to  which  they  are 
not  accustomed,  and  also  deprived  of  their  usual  exer- 
cise. This  causes  an  attack  of  indigestion,  with  very 
bad  effects  on  the  milk. 

A  wet-nurse  should  be  given  plain,  wholesome  food, 
and  besides  nourishing  the  infant,  should  be  allowed  to 


A  MOTHER'S   GUIDE  35 

help  in  caring  for  it,  and  also  to  take  it  for  its  daily 
airing.  She  must  have  sufficient  air  and  outdoor  exer- 
cise to  insure  her  keeping  in  good  health,  and  the  state 
of  her  bowels  should  receive  careful  attention. 

Wet-Nurse's  Own  Infant. — She  must  be  watched 
both  indoors  and  out  to  prevent  any  indiscretions  likely 
to  be  detrimental  to  the  health  of  her  charge;  but  it  is 
strongly  recommended  that,  where  possible,  she  be  al- 
lowed to  keep  her  own  infant  with  her.  By  allowing 
this  privilege,  you  are  likely  to  secure  a  better  class  of 
woman  than  otherwise,  and  do  not  run  the  risk  of  her 
milk  changing  as  a  result  of  her  worrying  over  her  own 
baby.  This  is  often  the  reason  why  a  wet-nurse's  milk 
fails  to  agree,  and  only  adds  to  the  troubles  of  the  sick 
infant. 

While  it  may  be  necessary  to  feed  a  wet-nurse's  own 
child  by  bottle,  it  is  good  policy  to  allow  him  two  or 
three  breast  feedings  a  day,  both  for  the  desirable  mental 
effect  on  the  mother,  and  also  because,  his  sucking  being 
stronger  than  the  sick  baby's,  it  will  encourage  the  flow 
of  milk.  Nursing  her  own  baby  must,  however,  be  done 
at  the  regular  nursing  hour  instead  of  the  foster  child's 
nursing,  or  if  the  milk  is  abundant,  immediately  after. 
The  two-  or  three-hour  intervals  between  nursings  must 
not  be  interrupted  by  the  nurse  suckling  her  own  child, 
otherwise  it  will  change  the  character  of  her  milk. 

A  wet-nurse  whose  milk  is  abundant,  will  be  able  to 
nourish  her  employer's  baby  as  well  as  her  own,  to  the 
great  benefit  of  both.  It  has  been  conclusively  shown 
that  a  good  wet-nurse  can  bring  up  her  own  baby  and 
one  or  two  other  infants  on  her  breasts.  At  Bellevue 
Hospital  two  wet-nurses  gave  five  quarts  of  milk  a  day 
between  them  and  nursed  fourteen  babies  three  times  a 
day.  A  wet-nurse  at  the  Babies'  Hospital  usually  nurses 
three  or  four  babies  several  times  a  day. 

Introduction  of  a  Bottle. — As  soon  as  a  sick  baby 


36  HOW  TO  TAKE  CARE  OF  THE  BABY 

has  started  to  gain  on  a  wet-nurse's  milk,  it  is  advisable 
to  begin  giving  him  one  or  two  bottles  of  modified  milk 
a  day,  so  that  he  may  be  gradually  accustomed  to  it  and 
the  wet-nurse  dispensed  with  as  soon  as  possible.  It  is 
also  a  wise  plan  to  adopt  as  a  precaution  in  case  of  the 
wet-nurse's  illness  or  sudden  departure. 

WEANING 

Reasons  for  Early  Weaning. — ^Under  normal  condi- 
tions, when  the  child  is  thriving,  and  the  mother  is  in 
good  health,  weaning  should  never  begin  before  the  age 
of  nine  or  ten  months,  but  conditions  often  arise  which 
make  early  weaning  imperative.     These  are: 

1.  Severe  illness  of  the  mother,  such  as  typhoid  fever, 
pneumonia,  etc. 

2.  Chronic  illness  or  weakness  of  the  mother. 

3.  Pregnancy. 

4.  Stationary  weight  of  a  child  for  two  weeks,  or 
steady  loss  of  weight  for  one  week,  for  no  assignable 
reason,  even  after  the  mother's  diet  and  hygiene  have 
been  attended  to. 

5.  When  the  milk  disagrees  in  spite  of  all  measures, 
and  the  child  suffers  from  colic,  green  stools,  vomiting, 
restlessness  and  sleeplessness. 

It  sometimes  happens  that  an  infant  will  not  thrive 
on  the  mother's  milk,  although  no  apparent  cause  can 
be  found,  the  milk  being  up  to  the  standard  both  in  qual- 
ity and  quantity.  In  this  case,  the  child's  symptoms 
must  be  the  only  guide,  and  weaning  should  be  resorted 
to  without  delay. 

Mixed  Feeding. — Often  when  a  child  loses  weight 
or  fails  to  gain,  it  is  advisable  to  begin  supplementary 
feedings  at  once,  but  he  need  not  be  taken  off  the  breast 
altogether,  and  mixed  feeding  can  be  continued  for  some 


A   MOTHER'S   GUIDE  37 

time  before  weaning  is  accomplished.  In  the  first  three 
conditions  mentioned  as  reasons  for  weaning,  it  must  of 
course  be  done  at  once,  and  the  child  put  on  a  very  weak 
formula  of  modified  milk. 

Avoid  Weaning  in  Summer. — Except  for  any  of  the 
foregoing  reasons,  weaning  should  not  be  attempted  in 
summer,  but  if  the  mother's  milk  is  becoming  scanty, 
mixed  feeding  may  be  begun.  At  this  season  the  greatest 
care  should  be  taken  in  introducing  cow's  milk,  the 
formula  must  be  much  weaker  than  the  one  usually 
given  for  the  child's  age,  and  if  there  is  any  epidemic 
of  summer  diarrhea,  or  typhoid  or  contagious  diseases, 
the  milk  should  be  pasteurized. 

Too  Sudden  Weaning  Apt  to  Cause  Indigestion. — 
As  a  general  rule,  and  under  normal  conditions,  nursing 
should  not  be  continued  in  any  case  after  the  twelfth 
month,  but  in  the  majority  of  cases,  weaning  should 
take  place  at  about  the  tenth  month,  as  the  milk  usually 
becomes  scanty  and  poor  in  quality  by  that  time.  Too 
sudden  weaning  is  liable  to  cause  indigestion,  therefore, 
it  should  be  done  gradually  in  the  following  manner.  At 
the  ninth  month  one  bottle  can  be  substituted  for  a  nurs- 
ing, or  if  the  child  is  accustomed  to  one  bottle  in  the  day, 
a  second  bottle  can  be  introduced.  After  an  interval  of 
three  or  four  days  another  may  be  given,  and  so  on,  until 
after  about  a  month's  time  the  child  will  be  entirely 
weaned. 

Drinking  From  Bottle. — If  the  child  has  been  trained 
to  drink  water  from  the  bottle,  or  has  been  given  one 
bottle  a  day  from  an  early  age,  as  has  been  advised  in 
another  chapter,  there  will  be  no  difficulty  in  getting  him 
to  take  his  food  from  the  bottle,  but  otherwise,  it  may 
require  a  little  coaxing  before  he  will  be  induced  to  take 
it.  Sometimes  actual  starvation  for  a  short  time  may 
have  to  be  resorted  to,  as  only  hunger  will  force  a  baby 


38  HOlW  to  take  care  OF  THE  BABY 

to  drink  from  the  bottle.  In  this  case  the  breast  should 
be  sternly  withheld  until  his  opposition  to  the  bottle  has 
been  overcome. 

Weaning  at  Twelve  Months  of  Age. — If  a  baby  is 
thriving,  and  gaining  steadily  in  v^^eight,  and  the  mother 
is  in  good  health,  and  particularly  if  summer  intervenes, 
it  is  wise  to  postpone  weaning  until  the  baby  is  twelve 
months  old.  At  this  age,  it  is  simpler  to  begin  teaching 
the  baby  to  drink  from  a  cup,  as  this  will  obviate  the  ne- 
cessity of  weaning  him  from  the  bottle  later  on. 

Teaching  to  Drink  From  a  Cup. — He  can  be  taught 
by  feeding  him  a  small  amount  at  a  time  from  a  tiny 
cup,  or  by  giving  him  a  little  from  a  spoon.  Some 
babies  will  take  milk  more  readily  from  a  cup  or  spoon 
than  from  a  bottle.  In  any  case,  by  the  age  of  fourteen 
months  the  use  of  the  bottle  should  be  discontinued,  ex- 
cept for  the  last  feeding  at  night,  which  may  be  given 
from  the  bottle,  as  the  child  would  be  too  much  roused 
by  feeding  from  a  cup  at  that  hour. 

If  a  child  has  been  allowed  to  drink  steadily  from  a 
bottle  until  the  second  or  third  year,  it  will  be  found 
very  much  harder  to  break  him  of  the  habit,  the  con- 
tinuation of  which  may  interfere  with  his  nutrition,  as 
he  will  often  be  unwilling  to  take  any  solid  food  from 
a  spoon.  In  obstinate  cases,  it  is  often  necessary  to  let 
him  remain  hungry  until  he  is  willing  to  drink  from  a 
cup. 

Loss  of  Weight  Likely  at  First. — For  the  first  week 
or  two  after  weaning  a  child  is  apt  to  lose  weight  until 
he  becomes  accustomed  to  cow's  milk,  after  which  he 
will  gain  steadily  and  often  more  rapidly  than  before. 

Care  in  Selection  of  Formula. — Signs  of  indigestion 
during  the  first  few  days  of  weaning  are  usually  due 
to  too  strong  a  mixture  of  cow's  milk,  and  a  child  who 
has  just  been  weaned  should  never  be  given  a  formula 
of  the  same  strength  as  would  be  given  to  a  bottle-fed 


A   MOTHER'S   GUIDE  39 

child  of  the  same  age.  For  instance,  if  a  child  is  weaned 
at  nine  months,  instead  of  giving  him  Formula  No.  13V^ 
the  usual  one  at  that  age,  he  must  begin  with  No.  8  or  No. 
9,  and  gradually  increase  it  until  he  is  taking  the  right 
formula  for  his  age  and  weight.  But,  being  older,  he 
can  take  a  large  quantity  of  the  weaker  formula,  viz., 
about  eight  ounces. 

Care  of  Breasts. — When  it  is  time  to  wean  the  in- 
fant or  when  only  two  nursings  are  given  per  day,  the 
times  for  nursing  should  be  gradually  set  farther  and 
farther  apart,  and  the  baby  nursed  only  when  the  breasts 
are  distended  and  painful.  In  about  eight  or  ten  days' 
time  the  breasts  will  be  dry. 

Sudden  Weaning. — If  weaning  has  to  be  done  sud- 
denly (owing  to  the  illness  of  the  mother,  etc.)  the 
breasts  should  be  tightly  compressed  by  a  bandage  around 
the  chest.  In  addition  to  this,  the  mother  should  abstain 
almost  entirely  from  fluids,  and  take  enough  of  some 
saline  laxative  such  as  Epsom  Salts,  Rochelle  Salts, 
Citrate  of  Magnesia,  etc.,  to  produce  three  or  four 
watery  stools  a  day.  If  in  bed,  she  should  have  in  ad- 
dition an  icebag  on  the  breasts. 

Drying  up  of  the  breasts  can  be  accomplished  in  a 
more  agreeable  manner  by  the  administration  of  potas- 
sium citrate,  twenty  to  thirty  grains,  dissolved  in  water, 
three  or  four  times  a  day,  thereby  producing  a  copious 
flow  of  urine. 

ARTIFICIAL  FEEDING 

A  Substitute  for  Mother's  Milk. — When  mother's 
milk  is  not  obtainable,  a  substitute  must  be  found  in  the 
fresh  milk  from  some  animal.  Cow's  milk  has  been 
found  the  most  satisfactory,  and  is  the  one  in  general 
use,  but  with  various  modifications.  Fresh  milk  in  some 
form  or  other  is  absolutely  necessary.     Other  foods. 


40  HOW  TO  JAKE  CARE  OF  THE  BABY 

alone,  may  appear  to  answer  the  purpose  for  a  short 
time,  but  there  is  danger  in  their  continuance,  for  scurvy, 
rickets,  or  malnutrition  will  be  sure  to  follow  their  pro- 
longed use. 

Composition  of  Cow's  Milk. — As  cow's  milk  is  very 
different  in  composition  from  mother's  milk,  our  object 
must  be  to  modify  it,  or,  in  other  words,  to  make  it 
more  nearly  resemble  mother's  milk,  and  furthermore, 
to  adapt  it  to  the  child's  age  and  digestive  capacity.  This 
can  be  successfully  accomplished  in  the  majority  of  cases, 
but  we  must  first  realize  the  essential  points  of  differ- 
ence, and  the  best  way  to  deal  with  them. 

Less  Sugar. — In  the  first  place,  as  cow's  milk  has 
much  less  sugar  than  mother's  milk,  a  certain  amount 
must  be  added;  this  is  a  necessary  article  of  diet,  it  is 
not  added  in  order  to  sweeten  the  milk. 

More  Protein. — Cow's  milk  contains  far  more  pro- 
tein or  curds,  and  usually  more  fat  or  cream  than 
mother's  milk,  and  moreover,  both  of  these  are  far  more 
indigestible.  We  overcome  this  by  the  use  of  diluents, 
and  by  adapting  the  strength  of  the  formula  to  the 
child's  individual  needs. 

Acidity  of  Cow's  Milk. — Cow's  milk  is  slightly  acid, 
but  as  a  rule  this  never  interferes  with  its  digestibility, 
especially  as  when  first  given,  it  is  greatly  diluted. 

Mother's  milk  is  always  fresh  and  sterile.  Cow's  milk 
can  never  be  quite  sterile,  but  by  taking  great  care  in 
the  milking  and  preparation,  we  can  make  it  safe  for 
use. 

Selection  of  Cow*s  Milk 

Herd  Milk. — In  the  selection  of  cow's  milk  for  arti- 
ficial feeding,  the  milk  from  a  mixed  herd  has  been 
found  more  suitable  than  that  from  a  single  cow,  for 
the  reason  that  the  milk  from  one  cow  is  apt  to  vary 


A   MOTHER'S   GUIDE  41 

from  day  to  day,  whereas  the  composition  of  herd  milk 
changes  very  Httle. 

Holsteins  or  Jerseys. — ^The  milk  of  Holsteins  or  or- 
dinary cows  is  to  be  recommended  for  infants  in  prefer- 
ence to  that  of  Jersey  or  Alderney  cows,  as  the  milk  of 
the  latter  is  very  much  richer  and  trouble  is  almost  sure 
to  result  if  due  allowance  is  not  made  for  this  when 
preparing  the  food;  for  whereas  the  Holstein  and  or- 
dinary cow's  milk  contains  four  per  cent,  fat  or  less,  that 
of  the  Jersey  or  Alderney  contains  about  five  and  a  half 
per  cent. 

Care  of  the  Milk. — As  regards  the  care  of  the  milk 
to  be  used  for  artificial  feeding,  the  chief  essentials  to  be 
borne  in  mind  are  that  the  cows  must  be  perfectly  healthy, 
and  the  milk  absolutely  fresh  and  clean.  In  order  to 
insure  this,  the  following  rules  laid  down  by  the  New 
York  Board  of  Health  in  regard  to  the  care  of  the  cow- 
stables,  may  be  of  use. 

Stables. — The  cow-stable  should  be  located  on  ele- 
vated ground  with  no  stagnant  water,  hog-pen,  or  privy 
within  one  hundred  feet.  The  floors  should  be  con- 
structed of  concrete,  stone,  or  some  non-absorbent  ma- 
terial ;  they  should  be  properly  graded  and  watertight. 
The  drops  should  be  of  the  same  material  and  frequently 
flushed  out  with  water. 

Windows  should  be  such  as  to  insure  free  ventilation, 
and  the  interior  of  the  stable  should  be  painted  or  white- 
washed, and  ceiling,  walls,  and  ledges  free  from  de- 
cayed animal  or  vegetable  matter,  dirt,  dust,  manure,  or 
cobwebs. 

Feeding  troughs,  platforms  or  cribs  must  be  well 
lighted  and  clean,  the  bedding  used  should  be  clean,  dry 
and  absorbent,  and  all  manure  removed  daily  to  at  least 
two  hundred  feet  from  the  bam,  and  so  placed  that  the 
cows  can  not  get  at  it.  The  liquid  matter  should  never  be 
allowed  to  overflow  or  saturate  the  ground  under  or 


42  HOW  TO  TAKE  CARE  OF  THE  BABY 

around  the  cow-barn.  No  sweeping  of  stables  should  be 
done  within  at  least  an  hour  before  milking  time,  so  that 
the  air  may  be  free  from  dust. 

The  water  supply  for  the  cows  should  be  unpolluted 
and  plentiful,  care  being  taken  that  there  is  no  stable, 
pile  of  manure,  or  other  source  of  contamination  within 
two  hundred  feet  of  the  source  of  the  water  supply,  and 
a  running  water  supply  for  washing  the  stables  should  be 
located  within  the  building.  The  cow  yard  should  be 
properly  graded  and  drained  and  kept  clean,  dry  and  free 
from  manure. 

Care  of  the  Cows. — A  separate  building  should  be 
provided  for  cows  when  sick,  and  also  for  cows  when 
calving.  There  should  be  no  live  stock,  other  than  cows, 
allowed  where  the  milk  cows  are  kept.  Cows  should  be 
examined  by  a  veterinarian  and  tested  by  tuberculin,  and 
all  tuberculous  cows  rejected. 

The  cows  must  be  kept  absolutely  clean  and  free  from 
clinging  manure  or  dirt,  and  the  long  hairs  kept  clipped 
on  belly,  flanks,  udder  and  tail.  The  udder  and  teats 
must  be  carefully  washed  before  milking.  All  feed 
should  be  of  good  quality  and  all  grain  and  coarse  fod- 
der free  from  dirt  and  mould.  The  cows  should  be  al- 
lowed to  graze  freely. 

Milk-Pails. — The  milk-pails  should  have  all  seams 
soldered  flush,  and  should  be  of  the  small  mouthed  de- 
sign, the  top  opening  not  exceeding  eight  inches.  They 
should  be  rinsed  with  cold  water  immediately  after  using, 
and  then  washed  with  hot  water  and  a  washing  solution, 
and  exposed  to  the  sun,  on  drying  racks  provided  for  the 
purpose. 

Milkers. — The  milkers  should  be  in  good  physical 
condition  and  wear  clean  clothes  and  special  milking 
suits ;  their  hands  should  be  carefully  washed  and  wiped 
just  before  milking. 

Milk  from  cows  within  fifteen  days  before  and  five 


A  MOTHER'S   GUIDE  43 

days  after  calving  must  not  be  used.  The  fore  milk  or 
first  few  strains  from  each  teat  should  be  discarded. 
After  milking,  the  milk  must  be  strained  through  sev- 
eral layers  of  clean  cheesecloth,  poured  into  bottles, 
which  have  been  previously  boiled,  corked,  or  sealed, 
cooled  in  water  and  then  placed  in  the  ice-box  in  close 
contact  with  the  ice. 

Care  of  Milk  and  Ice-Box. — When  milk  bottles  are 
not  obtainable  the  milk  can  be  poured  into  porcelain  or 
glass  jugs,  but  they  must  be  kept  covered  with  several 
thicknesses  of  cheesecloth,  which  are  kept  in  place  with 
an  elastic  ring.  The  cheesecloth  must  be  absolutely 
clean.  The  temperature  of  the  milk  should  never  be 
allowed  to  rise  above  50°  F.  The  milk  bottles  should 
therefore  be  placed  on  the  ice  or  surrounded  by  pieces 
of  ice.  Milk  not  so  kept  is  liable  to  go  bad  and  cause 
indigestion.  Thermos  or  vacuum  bottles  should  only  be 
used  for  keeping  the  milk  icy  cold.  If  the  milk  is  al- 
lowed to  remain  warm  it  will  be  unfit  for  the  baby  in 
a  very  short  time.  Care  should  be  taken  that  the  ice- 
box is  kept  clean  and  well  scoured,  and  that  no  decaying 
vegetable  matter  is  allowed  to  remain  in  it. 

Milk  more  than  twenty-four  hours  old  in  summer,  or 
forty-eight  hours  in  winter,  should  not  be  used,  unless 
for  a  journey,  and  in  that  case  it  should  be  first  sterilized 
and  then  kept  on  ice  until  wanted. 

Milk  in  Cities. — Inspected  milk  is  used  in  most  fam- 
ilies, hotels,  etc.,  and  is  good  for  all  ordinary  purposes. 

Certified  milk  is  nearly  double  the  price,  but  it  is 
purer,  and  the  quality  is  guaranteed.  It  should,  there- 
fore, be  used  for  babies  and  delicate  children. 

Milk  from  the  Walker-Gordon  laboratories  is  un- 
equaled  in  quality.  These  laboratories  will  make  up  any 
formulas  or  prescriptions  for  modified  milk,  when  it  is 
not  convenient  to  prepare  it  at  home.  For  journeys  or 
ocean  voyages,  they  will   furnish  milk  that  will  keep 


44  HOW  TO  TAKE  CARE  OF  THE  BABY 

fresh  and  sweet  for  weeks,  if  their  directions  are  fol- 
lowed. 

Thunderstorms. — During  thunderstorms  the  milk  is 
sometimes  soured,  even  in  the  ice-box.  It  is  a  good  plan, 
therefore,  to  taste  the  milk  after  every  thunderstorm, 
before  making  up  the  bottle. 

Preparation  of  Baby's  Food 

Articles  Required  for  Preparing  Food. — The  follow- 
ing articles  are  required  for  the  baby's  food,  and  must 
never  be  put  to  any  other  use. 

1.  A  nursery  refrigerator,  preferably  of  enameled 
metal  encased  in  wood,  and  arranged  so  that  the  bottles 
of  milk  will  be  close  to  the  ice. 

2.  A  small  table,  with  zinc  top,  or  covered  with  oil- 
cloth, on  which  the  food  should  be  prepared. 

3.  An  eight-ounce  glass  graduate. 


GHAPIN  CHEAM  DIPPER 


4.  A  Chapin  dipper  for  use  in  top-milk  mixtures. 
(Can  be  bought  for  twenty-five  cents.) 

5.  A  glass  jar,  with  cover,  containing  a  solution  of 
boric  acid  in  which  to  place  the  nipples  when  not  in  use. 

6.  A  white  pitcher  for  the  hot  water  in  which  to 
warm  the  baby's  bottle,  and  another  in  which  to  mix  the 
food. 

7.  A  bottle  brush  and  a  nipple  brush. 

8.  A  glass  funnel  for  pouring  the  mixture  into  the 
bottles. 

9.  A  basin  containing  borax  water  in  which  to  lay  the 
bottles  not  in  use. 


A   MOTHER'S   GUIDE 


45 


10.  An  electric  heater,  Bunsen  burner,  or  alcohol 
lamp,  and  a  saucepan  for  heating  water. 

11.  A  supply  of  absorbent  cotton  and  boric  acid. 

12.  The  bottles  should  be  graduated  up  to  eight  ounces, 
cylindrical,  wide-necked,  without  angles  or  corners,  and  it 
is  best  to  have  a  separate  one  for  each  feeding,  and  to 
fill  each  one  with  the  proper  amount  when  the  daily 
supply  is  prepared,  as  in  this  way  we  are  sure  that  the 
mixture  is  properly  shaken  and  distributed  for  the  day's 
feedings. 


FREEMAN  NURSING  BOTTLE 


WIRE  HOLDER  FOR  BOTTLES 


A  bottle  must  never  be  allowed  to  stand  after  using, 
and  any  milk  remaining  in  it  should  be  thrown  away. 
It  must  then  be  scrubbed  with  a  bottle-brush  in  hot 
soap-suds,  carefully  rinsed  in  hot  water,  and  stood  up- 
side down  to  drain,  or  placed  in  a  basin  of  borax  water 
(or  bicarbonate  of  soda)  until  needed.  The  bottles  need 
not  be  boiled,  if  cleaned  in  this  way. 

13.  A  wire  holder  for  keeping  the  bottles  in  an  up- 
right position  in  the  ice-box. 


46  HOW  TO  TAKE  CARE  OF  THE  BABY 

14.  A  supply  of  straight  black  rubber  nipples  that 
can  be  turned  inside  out,  and  without  holes.  It  is  better 
to  make  a  hole  of  the  required  size  with  a  hot  cambric 
needle.  The  hole  should  be  small  enough  to  allow  the 
milk  to  fall  in  single  drops  when  the  bottle  is  inverted, 
and  not  in  a  stream.  The  nipple  should  be  tested  fre- 
quently. Immediately  after  use,  nipples  must  be  thor- 
oughly washed  in  hot  soap-suds  and  water,  inside  and 
out,  rinsed,  and  left  in  the  boric  acid  solution  or  dried 
and  wrapped  in  sterile  gauze.  It  is  better  not  to  boil 
them,  except  for  a  minute  or  so  when  they  are  quite 
new,  as  they  deteriorate  very  rapidly  when  boiled. 

Cleanliness. — It  is  most  essential  that  all  the  uten- 
sils used  be  kept  absolutely  sweet  and  clean,  every  article 
should  receive  attention,  and  the  hands  of  the  mother 
or  nurse  must  be  carefully  washed  before  beginning 
the  preparation  of  the  baby's  food. 

Preparation,  of  the  Day's  Supply. — First  dissolve 
the  sugar  in  a  small  amount  of  hot  water  and  strain  it 
through  several  layers  of  cheesecloth  if  it  is  not  clear, 
then  add  to  it  sufficient  boiled  water  or  barley  water,  etc., 
which  has  been  previously  cooled,  to  make  up  the 
requisite  amount.  The  water  to  be  used  for  the  baby 
should  be  freshly  boiled  every  day,  and  kept  in  a  covered 
receptacle  until  needed.  Now  add  the  milk  and  lime 
water  to  the  sugar  solution,  mix  well,  and  pour  the  feed- 
ings into  each  bottle,  stopper  them  with  cotton,  place 
for  a  few  minutes  in  cold  water,  and  then  on  the  ice. 
When  they  are  to  be  pasteurized  or  sterilized  this  should 
be  done  before  cooling. 

To  Warm  Bottle. — To  warm  the  bottle  for  feeding, 
place  it  in  a  pitcher  filled  with  hot  water,  and  leave  it 
for  a  few  minutes ;  test  the  temperature  by  dropping  a 
little  on  the  inner  part  of  the  wrist.  If  the  temperature 
is  tested  by  tasting,  pour  a  little  in  a  spoon,  but  never 
touch  bottle  or  nipple  to  the  lips.    The  nipple  is  slipped 


A   MOTHER'S   GUIDE  47 

over  the  bottle  after  warming  and  the  bottle  well  shaken ; 
it  is  then  ready  for  use.  A  small  flannel  bag  with  a  draw- 
string slipped  over  the  bottle  will  prevent  its  cooling  too 
rapidly  during  feeding. 

How  to  Select  a  Formula 

Main  Points  to  Be  Considered. — Before  selecting  a 
formula,  the  chief  factors  to  be  taken  into  consideration 
are  the  age,  weight  and  condition  of  the  child.  In  young 
infants  the  weight  and  condition  must  be  our  chief 
guide,  the  age  being  of  secondary  importance.  Much 
depends,  also,  upon  whether  it  is  a  nursing  infant  quite 
unaccustomed  to  the  bottle,  or  one  already  used  to  one 
or  more  bottles  a  day. 

Weight. — Condition. — The  weight  of  the  infant  is 
a  good  guide  for  the  amount  to  be  given,  because  the 
size  of  the  stomach  is  usually  in  direct  proportion  to  the 
weight.  To  illustrate  these  remarks,  a  child  of  six  months 
weighing  only  eight  pounds,  whatever  its  condition  might 
be,  would  receive  less  than  one  of  the  same  age  weighing 
sixteen  pounds.  But  in  the  event  of  the  sixteen-pound 
baby's  being  upset,  we  may  have  to  give  him  temporarily 
the  same  strength  of  food  as  the  eight-pound  baby,  al- 
though the  quantity  would  be  larger.  Here  the  condition 
determines  the  strength  of  the  food ;  we  must  give  what 
can  be  digested.  For  this  reason  after  selecting  a  formula 
which  will  give  the  proper  strength  of  food,  we  are 
often  obliged  to  vary  according  to  individual  needs  the 
following  details  in  connection  with  the  feedings: 

1.  The  amount  at  each  feeding. 

2.  The  total  amount  in  the  day. 

3.  The  number  of  feedings  in  the  day. 

4.  The  length  of  the  intervals  between  feedings. 

5.  The  strength  of  the  food  and  its  composition. 
Often  No  Gain  in  Weight  at  First. — When  first  put 


48  HOW  TO  TAKE  CARE  OF  THE  BABY 

on  artificial  food,  infants  often  do  not  gain  in  weight 
immediately,  and  this  is  natural,  for  the  food  must  be 
made  weak  until  we  are  quite  sure  that  the  child  is  di- 
gesting it  properly. 

When  Starting  on  a  Formula. — When  called  upon 
to  select  a  formula  for  an  infant  about  whose  constitu- 
tion, digestive  abilities,  etc.,  we  know  nothing,  always 
begin  with  a  weak  mixture,  then  watch  his  symptoms 
very  carefully;  if  these  are  favorable,  gradually  increase 
the  amount  and  strength  of  the  food.  For  instance,  a 
child,  two  months  old,  weighing  ten  and  a  half  pounds, 
should  get  Formula  No.  8,  but  begin  with  Formula  No.  5. 

Hov/  to  Increase. — Never  increase  both  at  once,  but 
begin  at  first  with  a  larger  quantity  (this  increase  should 
not  be  more  than  one-half  ounce  at  a  feeding),  and  after 
three  or  four  days,  if  the  child  does  not  gain  satisfac- 
torily in  weight,  the  food  may  be  strengthened.  The 
maximum  amounts  for  its  age  should  not  be  exceeded, 
for  this  is  liable  to  distend  the  stomach  unnecessarily. 
(See  feeding  schedule,  page  54.) 

Indications  for  Increasing  the  Food. — ^The  younger 
the  infant  the  more  rapidly  is  the  step  taken  from  one 
formula  to  the  next,  providing  all  the  child's  symptoms 
warrant  the  increase. 

These  indications  are: 

1.  The  weight,  see  page  120,  viz.,  little  or  no  gain. 

2.  The  digestion. 

Normal  stools  and  absence  of  vomiting. 

3.  Symptoms  of  hunger. 

The  child  shows  these  by  taking  the  bottle  very  eagerly 
and  quickly,  by  appearing  unsatisfied  when  it  is  fin- 
ished, and  by  crying  before  it  is  time  for  the  next  feed- 
ing. 

All  these  symptoms  being  present,  it  will  be  advisable 
to  try  the  next  formula.  If  after  three  or  four  days 
he  still  does  not  gain  in  weight,  but  sleeps  well  and  is 


A  MOTHER'S   GUIDE  49 

comfortable,  it  is  safe  to  increase  still  further  the  food, 
but  very  gradually,  as  before. 

The  food  should  never  be  increased  in  quality  or 
quantity  at  intervals  of  less  than  three  days,  in  order 
to  give  enough  time  to  observe  carefully  the  effects  of 
the  former  change. 

When  Not  to  Increase  the  Food. — ^When  a  child  is 
doing  well  on  a  certain  formula,  is  comfortable,  sleeps 
well,  and  is  gaining  normally  in  weight,  do  not  on  any 
account  change  the  food  or  select  a  stronger  formula, 
although  the  one  he  is  taking  may  be  weaker  than  the 
one  laid  down  in  the  schedule  for  his  age  and  weight. 

When  an  infant  is  gaining  from  four  to  six  ounces 
a  week  or  more  any  increase  is  inadvisable,  even  if  his 
appetite  seems  to  demand  it.  Instead,  give  more  water 
between  feedings. 

Thirst  from  Heat. — A  child  will  sometimes  be  rest- 
less and  show  signs  of  thirst  in  very  warm  weather,  or 
as  a  result  of  overheated  rooms  or  too  much  clothing. 
This  may  be  mistaken  for  hunger,  and  the  child  overfed 
in  consequence,  whereas  the  proper  treatment  under  these 
circumstances  is  to  give  a  drink  of  warm  water  between 
feedings.  The  amount  may  vary,  but  a  safe  guide  is 
to  give  not  more  than  half  the  amount  of  the  usual  feed- 
ing, using  water  previously  boiled  and  cooled  to  about 
100°  F.  A  pinch  of  sugar  may  be  added.  This  should 
not  be  given  less  than  one  hour  before  or  after  the 
feeding. 

When  the  Increase  is  Followed  by  Indigestion. — 
Some  infants  are  slightly  upset  by  an  increase  in  food, 
and  in  these  cases  it  is  safer  to  return  to  the  old  formula 
for  a  while ;  then  after  recovery,  to  make  the  increase 
more  gradual  than  before ;  e.  g.,  give  half  an  ounce  more 
in  every  alternate  bottle  at  first. 

Indications  for  Reducing  the  Food. — The  food 
should  be  promptly  reduced,  especially  in  strength,  when 


50  HOW  TO  TAKE  CARE  OF  THE  BABY 

the  child  shows  any  symptoms  of  indigestion  (see  chap- 
ter on  Indigestion),  or  in  any  case  of  illness,  whether 
trifling  or  severe.  When  the  symptoms  are  severe,  food 
should  be  entirely  withheld,  and  only  water  given  until 
the  arrival  of  the  physician. 

No  hard  and  fast  rules  can  ever  be  laid  down  covering 
all  feeding  cases.  The  age,  weight,  condition  and  peculi- 
arities of  each  child  have  to  be  taken  into  account  and 
separately  considered. 

Food  for  Healthy  Infants 

The  Preparation  of  Suitable  Formulas. — In  the 
preparation  of  formulas  for  the  use  of  infants,  it  must 
be  taken  into  consideration  that  while  a  child  can  usually 
digest  mother's  milk,  he  has  to  be  educated  to  digest 
cow's  milk.  As  it  is  impossible  to  tell  beforehand  what 
amount  of  fat  or  protein  a  particular  infant  will  be  able 
to  digest,  it  is  safer  to  begin  with  low  percentages  of 
these  ingredients,  and  gradually  increase  them  until  the 
child  is  taking  an  amount  suitable  to  his  age  and  weight. 
In  this  way  we  shall  avoid  serious  disturbances  of  di- 
gestion. 

There  are  five  grades  of  milk  which  I  shall  consider, 
differing  only  in  the  percentage  of  fat  they  contain. 

Different  Grades  of  Milk. — 1.  Skimmed  milk,  con- 
taining about  lyz  per  cent,  fat;  page  59. 

2.  Milk  from  Holstein  cows,  containing  about  3^ 
per  cent.  fat. 

3.  Milk  from  a  mixed  herd,  containing  about  4  per 
cent.  fat. 

4.  Milk  from  Jersey  or  Alderney  cows,  containing 
about  5^  per  cent.  fat. 

5.  "Top-milk,"  specially  prepared,  containing  about 
7  per  cent.  fat.    For  directions  see  page  56. 


A   MOTHER'S   GUIDE  51 

The  milk  supply  In  most  cities  in  this  country  is  ob- 
tained from  mixed  herds,  and  contains  about  four  per 
cent,  fat  when  supplied  by  a  reliable  firm.  Jersey  and 
other  cow's  milk  containing  about  five  and  a  half  per  cent, 
fat  is  only  obtainable  from  private  farms. 

The  preparation  of  top-milk  mixtures  from  the  last 
four  varieties  is  explained  elsewhere. 

Whole  Milk  vs.  Top-Milk. — Some  authors  recom- 
mend starting  in  the  first  few  weeks  of  life  with  top- 
milk,  or  the  addition  of  cream  to  the  milk  in  order  to 
make  the  mixture  richer  in  fat.  As  the  infant's  stom- 
ach is  accommodating  itself  to  foreign  food,  and  a  dis- 
turbance of  digestion  at  this  early  period  of  life  is  a 
very  serious  matter,  I  have  found  it  safer  to  begin  on 
a  whole  milk  mixture  of  four  per  cent,  fat  in  proportions 
that  we  are  reasonably  sure  the  child  will  digest.  It  is 
a  simple  matter  to  add  more  fat  later  if  we  are  sure  that 
it  can  be  safely  borne.  This  would  be  done  when  a  slow 
gain  in  weight  and  constipation  follow  the  whole  milk 
feeding,  for  these  symptoms  are  easily  corrected,  while 
the  same  can  not  be  said  of  an  upset  caused  by  a  mixture 
too  rich  in  fat. 

Whole  Milk. — We  shall  then  begin  with  the  whole 
milk  formulas,  and  it  is  understood  that  whole  milk 
(from  which  no  cream  has  been  taken)  from  a  mixed 
herd  of  cows  is  to  be  used,  and  the  bottle  thoroughly 
shaken  before  pouring  out  the  number  of  ounces  re- 
quired.   This  milk  will  contain  about  four  per  cent.  fat. 

Milk  from  Aldemeys. — If,  however,  only  the  milk 
from  Jersey  or  Alderney  cows  is  procurable,  it  will  con- 
tain about  five  and  a  half  per  cent,  fat,  and  must  be 
treated  in  the  following  manner.  The  milk  must  remain 
undisturbed  in  the  quart  bottle  in  the  ice-box  for  four 
hours.  At  the  end  of  that  time  the  upper  three  ounces 
should  be  carefully  removed  with  a  Chapin  dipper.    The 


52  HOW  TO  TAKE  CARE  OF  THE  BABY 

remaining  contents  of  the  bottle  must  be  thoroughly 
shaken,  and  from  this  the  milk  is  poured  out  for  use 
in  the  formulas. 

SUGAR 

The  different  kinds  of  sugars  suitable  for  infant  feed- 
ing are  described  below. 

Milk  Sugar. — Milk  sugar  is  most  commonly  used 
by  those  who  can  afford  it,  but  only  the  best  grades,  such 
as  Squibb's,  should  be  given.  The  cheaper  grades  are 
harmful,  and  are  often  the  cause  of  inexplicable  intes- 
tinal disturbances. 

The  amount  to  be  given  is  mentioned  on  page  54.  (See 
also  "Measures,"  on  page  158.) 

Cane  Sugar. — Cane  sugar,  or  the  ordinary  white 
granulated  sugar,  is  very  much  cheaper  than  milk  sugar, 
and  will  suit  many  healthy  babies.  Owing  to  its  rela- 
tive cheapness,  it  is  often  given  in  excess,  and  therefore 
disagrees.  As  cane  sugar  is  twice  as  sweet  as  milk  sugar, 
not  more  than  half  the  amount  by  measure  should  be 
given. 

Delicate  infants  and  those  suffering  from  diarrhea 
with  much  gas  will  do  better  on  pure  milk  sugar  than 
on  cane  sugar. 

Malt  Sugars. — Malt  sugar  is  very  useful  in  cases 
where  the  digestion  is  not  normal,  and  the  weight  less 
than  it  should  be.  It  must  not  be  given,  however,  when 
there  is  any  vomiting  or  diarrhea. 

There  are  several  kinds  in  powder  form  and  two  kinds 
in  liquid  form.  The  former  are  "Dextri-Maltose"  (Mead, 
Johnston  &  Co.'s,  Jersey  City),  "Mellin's  Food,"  "Bor- 
den's Malted  Milk,"  and  "Horlick's  Malted  Milk."  From 
two  or  three  level  tablespoonfuls  of  any  of  these  prep- 
arations should  be  added  to  every  twenty  ounces  of  milk 
mixture.  The  formulas  on  page  54  should  be  adhered 
to,  but  omitting  the  cane  or  milk  sugar. 


A   MOTHER'S   GUIDE  53 

The  liquid  preparations  are  "Loeflund's  Malt  Soup" 
and  "Maltzymose."  They  should  be  used  as  follows : 
Prepare  the  day's  feeding  without  sugar  and  add  two 
teaspoonfuls  of  either  of  the  above  liquids  and  the  milk 
to  the  barley-water  (when  the  latter  has  been  cooked) 
and  bring  the  whole  to  a  boil.  Increase  the  amount  by 
one  teaspoon ful  every  day  until  the  stools  begin  to  get 
loose,  then  reduce  it  by  two  or  three  teaspoonfuls,  until 
the  bowels  are  again  normal.  These  liquid  malt  sugars 
give  a  chocolate  color  to  the  stools. 

N.  B. — 1.  Loeflund's  Malt  Soup  is  obtainable  from  Messrs. 
Britt,  Loeffler  &  Weil,  225  Canal  St..  N.  Y.  City. 

2.  Maltzymose  is  made  by  the  Maltzyme  Co.,  of  Brooklyn, 
N.  Y.  These  preparations  can  be  ordered  through  any  drug 
store. 

Amounts  of  Formulas. — For  the  sake  of  conveni- 
ence, the  formulas  are  given  in  20-oz.  mixtures.  If  30 
oz.  are  required,  it  will  be  easy  to  add  half  the  amount 
again  to  those  already  given,  and  if  40  oz.  are  needed, 
the  amounts  given  in  the  formulas  are  doubled.  On  the 
other  hand  if  only  10  oz.  are  required,  we  take  half  the 
amount  of  everything  in  the  formula.  Formulas  as  given 
below  are  referred  to  as  "2  in  20"  or  "5  in  20,"  etc.,  the 
two  or  the  five  being  the  number  of  ounces  of  milk  in  a 
total  mixture  of  20  oz.  In  this  way  the  mother  knows 
not  only  the  number  of  the  formula,  but  also  the  propor- 
tion of  the  ingredients.  It  must  be  borne  in  mind  that 
these  formulas  are  only  intended  for  normal,  healthy 
infants. 


54     HOW  TO  TAKE  CARE  OF  THE  BABY 


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A   MOTHER'S   GUIDE 


55 


It  will  be  noticed  that  there  are  no  feedings  at  less 
than  three-hour  intervals.  There  is  a  good  reason  for 
this,  viz. :  cow's  milk  can  not  be  digested  under  two  and  a 
half  hours,  and,  as  the  baby  should  take  his  bottle  in  from 
fifteen  to  twenty  minutes,  it  is  unwise  to  feed  him  at  a 
shorter  interval  than  three  hours.  Digestive  disorders 
are  thus  avoided  from  the  beginning. 

Example  of  feeding  according  to  the  above  schedule. 


No.  of  Formula. . 

Age   

Weight   

Amount  at  each 
feeding 

Total  amount  for 
the  day 

Intervals  between 
feedings 

Number  of  feed- 
ings in  the  24 
hours 

Hours  for  feeding 


Formula  No.  10  should  be  given 
to  a  child  5  months  old 

weighing  about   14^   pounds. 

Between  5  and  6  ounces  should  be 
given  at  a  feeding,  and 

Between  30  and  36  ounces  in  the 
24  hours. 

The  intervals  should  be  3  hours. 

There  should  be  6  feedings  in  the 
24  hours. 

These  are  6,  9,  a.  m.,  and  12,  3,  6 
and  10,  p.  m. 

These  formulas  are  given  only  as  a  guide,  for  it  does 
not  follow  that  two  children  of  the  same  age  or  weight 
will  take  the  same  formulas  or  amounts.  The  mother 
should  judge  by  the  symptoms  of  overfeeding  or  under- 
feeding, as  mentioned  in  the  chapter  on  Nursing,  on 
pages  27  and  29. 

Barley  Water. — Barley  water  may  be  substituted 
for  the  plain  water  in  the  formulas  when  the  infant  is 
three  or  four  months  old.  The  nutritive  value  of  barley 
water  is  very  small,  but  in  many  cases  when  the  milk  is 
not  well  digested,  it  helps  to  break  up  the  curds  in  the 
stomach,  and  thus  assists  in  better  assimilation  of  the 
food. 


56  HOW  TO  TAKE  CARE  OF  THE  BABY 

Night  Feeding. — In  the  schedule  under  the  headings 
for  intervals  of  three  hours,  I  have  recommended  the  last 
feeding  to  be  given  at  10  p.  m.  instead  of  9  p.  m.,  which 
would  be  the  correct  hour  according  to  the  intervals.  I 
have  made  the  change  in  this  case,  because  it  has  been 
my  experience,  that  when  the  last  feeding  is  given  a  little 
later  at  this  age,  babies  are  m.ore  apt  to  sleep  through 
the  night  without  waking,  and  this  habit  should  be  en- 
couraged and  the  night  feeding  discontinued  as  soon  as 
possible. 

Larger  and  Smaller  Amounts  Given  in  Schedule. — 
It  must  be  remembered  that  the  lesser  amounts  given 
are  for  small-sized  and  delicate  children,  and  the  larger 
amounts  for  robust,  large-sized  children.  The  larger 
quantities  should  never  be  exceeded,  except  in  rare 
cases. 

Higher  Formula. — A  higher  formula  than  the  one 
suitable  to  the  child's  age  (see  page  54)  is  only  indicated 
when  a  baby  is  taking  the  maximum  amount  of  such  a 
formula  and  is  not  gaining,  and  otherwise  shows  signs 
of  insufficient  nourishment  (see  heading  Scanty  Milk,  on 
page  29),  but  does  not  vomit  nor  show  any  symptoms 
of  indigestion. 

Top-Milk.  How  to  Prepare  It. — Let  the  bottle  of 
milk  stand  undisturbed  for  four  hours  in  the  ice-box.  If 
it  is  herd  milk  containing  4  per  cent,  fat,  remove  16  oz. 
with  a  Chapin  dipper;  if  Jersey  or  Alderney  milk  is 
used,  remove  24  oz. ;  if  Holstein  milk,  then  only  12  oz. 
The  milk  taken  out  in  this  way  will  be  so-called  top-milk, 
and  will  contain  7  per  cent.  fat.  Shake  this  and  from  it 
take  the  number  of  ounces  required  and  proceed  to  make 
up  the  formulas  as  before.  (See  schedule.)  When 
using  top-milk,  a  stronger  mixture  than  Formula  No.  9 
should  not  be  given.  This  formula  calls  for  9  ounces 
of  top-milk  in  20  ounces,  and  consequently  contains  a 
little  more  than  3  per  cent.  fat.     Very  few  infants  can 


A   MOTHER'S   GUIDE  57 

stand  a  higher  percentage  of  fat  than  this,  so  after  using 
No.  9  formula  with  top-milk  it  is  wiser  to  make  the 
next  step  a  No.  10  formula  with  whole  milk. 

An  intermediate  stage  between  whole  milk  (4  per 
cent,  fat)  and  top-milk  (7  per  cent,  fat)  is  the  milk  from 
Jersey,  Alderney,  or  Guernsey  cows  containing  about 
5y^  per  cent.  fat.  After  shaking  up  the  bottle,  use  it  ac- 
cording to  the  directions  given  for  milk  from  a  mixed 
herd,  but  do  not  give  a  stronger  mixture  than  Formula 
No.  12,  as  this  would  contain  slightly  over  3  per  cent, 
fat.  After  No.  12  formula  with  Jersey  milk  give  No.  13 
formula  with  milk  from  a  mixed  herd. 

Remarks. — Personally  I  am  not  an  advocate  of  top- 
milk  mixtures,  except  in  very  rare  and  special  cases.  I 
have  seen  more  harm  than  good  result  from  their  use,  as 
for  most  infants  the  fat  or  cream  in  cow's  milk  is  the 
ingredient  most  difficult  of  digestion.  Children  upset 
as  a  result  of  too  much  cream  do  not  recover  for  a  long 
time,  and  even  after  recovery  require  very  careful  feed- 
ing. 

Top-milk  or  the  addition  of  cream  to  an  infant's  food, 
for  the  purpose  of  increasing  the  percentage  of  fat  in 
the  mixture,  originated  a  few  years  ago  from  the  idea 
of  modifying  cow's  milk  so  as  to  make  its  composition 
the  same  as  mother's  milk. 

To  explain  this,  I  shall  first  give  a  table  showing  the 
average  composition  of  mother's  milk  and  cow's  milk. 

Fat.         Sugar.        Protein. 

Mother's   milk 4%         7      %         1.50% 

Cow's   milk 4%         4.50%         3.50% 

As  can  be  seen,  cow's  milk  contains  more  than  double 
the  amount  of  protein  and  a  little  more  than  half  the 
quantity  of  sugar  that  mother's  milk  contains. 

To  make  the  cow's  milk  more  like  mother's  milk,  it 
was  greatly  diluted,  and  then  sugar  and  cream  were 
added.      Chemically   the   two   milks   were   now   almost 


58  HOW  TO  TAKE  CARE  OF  THE  BABY 

identical,  but  in  digestibility  they  were  far  apart.  With- 
out any  experience  to  warrant  it,  this  modification  of 
top-milk  was  at  once  advocated  and  tried  on  infants, 
generally  with  disastrous  results.  Many  physicians  have 
now  discarded  it. 

The  old  notion  prevailed  that  all  curds  in  the  stools 
were  composed  of  undigested  protein,  but  we  now  know 
that  curds  are  often  composed  of  fat.  The  protein  of 
cow's  milk  is  not  so  indigestible  as  it  was  thought  to  be, 
and  in  most  cases  of  indigestion  in  infants  we  can  put 
the  blame  on  the  cream. 

Do  we  not  all  know  of  children  sufifering  from  indi- 
gestion who  have  been  benefited  by  skimmed  milk  or 
buttermilk?  In  both  of  these  the  percentage  of  fat  is 
very  low,  but  the  protein  is  the  same  in  amount  as  in 
unaltered  milk.  To  give  cream  under  these  circum- 
stances would  be  to  court  disaster. 

Fat  a  Necessary  Ingredient. — Although  it  is  the 
cream  or  fat  that  is  the  ingredient  most  difficult  of  di- 
gestion, still  it  is  very  often  essential  for  an  infant  to 
have  some  form  of  fat,  for  it  produces  heat  and  energy, 
prevents  waste  of  the  tissues  of  the  body,  is  a  natural 
laxative  and  assists  in  the  growth  of  bone  and  nerve 
tissues.  Lack  of  fat  produces  emaciation,  constipation, 
rickets,  etc. 

Top-milk  would  be  occasionally  indicated  in  the  case 
where  the  healthy  infant  is  getting  the  formula  suitable 
for  his  age  and  weight,  but  is  gaining  very  little  or  not 
at  all,  is  constipated,  but  has  no  other  symptoms.  I  am 
distinctly  opposed  to  top-milk,  but  if  it  is  given,  the 
infant  must  be  watched  very  carefully.  If  the  top-milk 
disagrees,  we  must  go  back  to  whole  milk  or  even  to 
skimmed  milk  and  give  olive  oil  in  small  quantities,  to 
take  the  place  of  cream,  for  a  short  time,  until  the  symp- 
toms improve. 

Olive  Oil. — As  a  result  of  recent  experiments  it  has 


A  MOTHER'S   GUIDE  59 

been  found  that  a  pure  vegetable  oil,  like  olive  oil,  can 
not  only  take  the  place  of  cream,  but  that  it  is  very  di- 
gestible and  can  be  given  to  infants  who  could  not  pre- 
viously tolerate  the  smallest  percentage  of  cream.  They 
do  not  gain  in  weight  on  it,  but  it  prevents  them  losing. 

Olive  oil  should  be  given  in  small  quantities,  begin- 
ning with  half  a  teaspoonful  three  times  a  day,  just  after 
giving  the  bottle.  It  may  be  increased  gradually,  to  a 
maximum  of  six  teaspoonfuls  a  day,  and  should  always 
be  given  in  divided  doses,  after  each  feeding. 

Skimmed  Milk. — Skimmed  milk  is  useful  in  certain 
cases  of  indigestion  and  where  infants  have  been  upset 
from  mixtures  too  rich  in  cream,  and  should  be  given  in 
every  case  of  vomiting  until  the  cause  is  known.  It  is 
taken  from  whole  milk  by  allowing  the  bottle  to  stand 
four  hours  in  the  ice-box,  and  then  carefully  removing 
the  upper  four  ounces  with  a  Chapin  dipper.  The  remain- 
der is  shaken  up  and  used  in  making  the  required  form- 
ula. If  the  milk  is  from  Jersey  cows,  remove  the  upper 
six  ounces  and  use  the  rest,  as  before. 

General  Directions  for  Feeding 

Position  During  Feeding. — For  the  first  two  or 
three  months  the  baby  should  lie  in  a  semi-reclining  posi- 
tion in  the  mother's  or  nurse's  arms  for  all  feedings  in 
the  daytime.  At  night,  for  the  sake  of  warmth,  the 
child  can  be  placed  on  its  side  in  bed,  and  the  bottle  held 
in  its  mouth.  An  infant  requires  attention  during  the 
entire  time  of  feeding,  and  the  bottle  must  never  be  left 
lying  on  the  pillow  to  be  sucked  at  will,  as  the  child 
may  draw  in  air  owing  to  the  bottle  not  being  at  the 
proper  angle ;  or  he  may  alternately  suck  and  fall  asleep, 
and  will  be  too  long  over  the  bottle.  A  sleepy  infant 
may  be  kept  awake  by  gentle  tapping  or  shaking,  but 
if  twenty  minutes  have  elapsed,  and  the  bottle  is  still 


60  HOW  TO  JAKE  CARE  OF  THE  BABY 

unfinished,  it  should  be  removed,  the  milk  thrown  away 
and  no  more  offered  until  the  next  feeding-time. 

After  Feeding. — The  baby's  diaper  should  be 
changed  before  giving  the  bottle,  so  that  immediately 
after  the  feeding  he  may  be  placed  in  the  crib,  and  not 
disturbed  in  any  way.  Playing  with  or  exciting  a  baby 
at  this  time  is  often  the  cause  of  vomiting  or  indigestion. 
If  the  child  is  perfectly  healthy  and  comfortable,  and 
has  been  properly  trained,  he  will  be  quite  content  to  lie 
quiet  in  his  crib  after  the  feeding  even  if  he  does  not 
sleep.  Should  he  cry,  it  is  well  to  examine  his  diaper, 
or  to  pick  him  up  gently,  lay  him  against  the  shoulder, 
and  pat  him  gently  on  the  back  for  a  minute  or  so,  as 
a  little  wind  in  the  stomach  may  be  the  cause,  and  if  he 
succeeds  in  getting  rid  of  it,  he  will  be  perfectly  quiet 
when  replaced  in  his  crib. 

Waking  for  Feedings. — ^A  baby  must  be  wakened 
through  the  day  for  his  feedings,  and  he  should  be  fed 
at  regular  intervals,  and  at  the  exact  time  by  the  clock, 
the  same  hours  every  day  being  rigidly  adhered  to.  The 
child  will  thus  be  taught  regular  habits,  and  in  a  short 
time  will  learn  to  wake  of  his  own  accord  for  his  bottle. 

Night  Feedings. — After  nine  or  ten  o'clock  at  night, 
however,  a  baby  should  be  allowed  to  sleep  as  long  as 
he  will  and  the  night  feeding  given  when  he  wakes  of 
his  own  accord.  This  feeding  should  be  discontinued  as 
soon  as  possible  after  birth,  and  never  given,  in  any 
case,  after  the  child  is  four  or  five  months  old,  when  he 
should  sleep  from  10  p.  m.  to  6  a.  m.  without  waking. 

Time  Allowed  for  Feeding. — Twenty  minutes  should 
be  the  regular  time  allowed  for  each  feeding,  and  if  the 
hole  in  the  nipple  is  properly  regulated  it  will  take  a 
healthy  baby  fifteen  to  twenty  minutes  to  consume  the 
amount.  If  he  takes  it  in  a  shorter  time  he  is  likely  to 
regurgitate  or  suffer  from  indigestion.  If  he  drinks  too 
eagerly,    the  bottle  should  be  taken  out  of  his  mouth  re- 


A   MOTHER'S   GUIDE  61 

peatedly  for  a  few  seconds  at  a  time,  but  care  must  be 
exercised  in  doing  this,  as  a  sudden  pull  on  the  bottle 
might  injure  his  tongue,  which  is  tightly  curled  around 
the  nipple. 

Intervals. — The  intervals  which  are  counted  from 
the  beginning  of  one  feeding  to  the  beginning  of  the 
next,  should  be  strictly  adhered  to,  except  during  severe 
illness  or  on  the  advice  of  a  physician.  These  intervals 
should  never  be  shortened,  even  in  the  case  of  a  nursing 
baby,  and  still  less  so  with  a  bottle-fed  baby,  for  if  a 
fresh  feeding  is  added  to  a  variable  amount  of  partially 
digested  food  in  the  stomach,  it  is  sure  to  result  in 
colic,  indigestion,  vomiting,  etc. 

Lengthening  of  Intervals. — On  the  other  hand,  bot- 
tle-fed infants  often  do  better,  even  in  the  earliest  weeks 
of  life,  when  the  intervals  between  feedings  are  length- 
ened to  four  hours  instead  of  three.  This  is  due  to  the 
fact  that  it  takes  cow's  milk  nearly  three  hours  to  digest, 
as  has  been  proved  by  various  experiments.  The  older 
the  child  grows,  the  more  milk  is  consumed,  and  the 
longer  the  process  of  digestion  will  take,  consequently  we 
lengthen  the  periods  of  time  between  feedings.  They 
should  not  be  less  than  three  hours  and  not  more  than 
four  hours,  depending  on  the  age  and  condition  of  the 
child.  The  intervals  should  always  be  lengthened  when 
the  child  suffers  from  loss  of  appetite,  does  not  finish  his 
bottle,  vomits  or  regurgitates  after  feeding,  or  during 
any  attack  of  indigestion  or  illness. 

Treatment  of  Healthy  Babies. — It  has  been  stated 
that  babies  should  be  left  undisturbed  in  their  cribs  after 
feeding,  but  this  does  not  mean  that  a  child  is  to  be  left 
lying  in  its  crib  all  day.  In  fact,  it  is  essential  to  a  baby's 
development  that  it  be  carried  about  in  the  arms  from 
time  to  time,  as  this  will  take  the  place  of  exercise  for 
a  baby  not  yet  able  to  walk.  The  times  for  doing  so, 
however,  should  be  before  feeding,  not  after.     If  it  is 


62  HOW  TO  TAKE  CARE  OF  THE  BABY 

seen  that  a  child  is  crying  simply  as  a  result  of  injudi- 
cious petting,  and  when  it  is  not  uncomfortable  in  any 
way  or  suffering  from  indigestion,  he  should  not  be  in- 
dulged, but  rather  allowed  to  have  his  cry  out,  as  this 
will  do  him  no  harm,  and  he  will  soon  get  back  into 
regular  habits.  Of  course,  exceptions  must  be  made  in 
the  case  of  very  sick  babies,  as  these  have  a  right  to  be 
"mothered,"  and  ought  not  to  be  allowed  to  cry  very 
long.  They  should  be  indulged,  however,  only  during 
the  time  of  their  illness,  after  which  they  must  be  grad- 
ually trained  back  into  their  former  habits. 

ADDITIONAL  FOOD  DURING  THE  FIRST 
YEAR 

(For  Recipes,  see  page  154.) 

Barley  Water. — When  the  child  is  three  or  four 
months  old  barley  water  may  be  added  to  the  milk  mix- 
ture in  place  of  the  water,  as  it  often  assists  in  the  di- 
gestion of  the  milk. 

Gruels. — Gruels,  in  small  quantities,  beginning  with 
one  ounce,  may  be  added  to  the  twenty-ounce  mixture  in 
place  of  an  equal  amount  of  water  after  the  seventh  or 
eighth  month,  and  increased  until,  at  twelve  months  of 
age,  five  ounces  of  gruel  are  given.  The  gruel  should  be 
cooked  separately,  and  added  to  the  milk,  then  allowed  to 
cool  a  little,  after  which  the  other  ingredients  are  added. 

Beef  Juice. — This  must  be  diluted  with  an  equal 
amount  of  cold  water.  It  should  be  given  once  a  day, 
just  before  midday  or  first  afternoon  feeding.  Begin 
with  two  teaspoonfuls  and  gradually  increase  to  one 
ounce  or  eight  teaspoonfuls  in  the  course  of  a  month  or 
two.  Beef  juice  should  always  be  given  after  nine 
months  of  age,  but  delicate  children  will  be  benefited 
by  giving  it  in  small  quantities  as  early  as  six  months, 
beginning  with  one  teaspoon  ful.  At  one  year,  two  or 
three  tablespoonfuls  may  be  given,  but  never  more. 


A   MOTHER'S   GUIDE  63 

White  of  Eggs. — Half  the  white  of  a  coddled  egg 
may  be  given  at  six  months  once  a  day  just  before  the 
midday  bottle  and  increased  to  the  whole  white  in  a  few 
weeks.  This  is  especially  useful  when  the  protein  of 
cow's  milk  is  not  properly  digested.  Beef  juice  and  the 
white  of  egg  must  not  be  given  on  the  same  day,  but 
should  be  served  on  alternate  days. 

Orange  Juice. — The  juice  of  a  fresH  sweet  orange 
may  be  given  at  six  months  of  age,  beginning  with  two 
teaspoonfuls  one  hour  before  the  second  feeding  of  the 
day,  and  increasing  the  amount  to  one  or  two  ounces  by 
the  end  of  the  year.  It  must  always  be  strained.  Some 
children  can  not  take  orange  juice ;  in  that  case  the  juice 
of  boiled  prunes  or  strained  apple  sauce  may  be  substi- 
tuted. 

Other  Articles  of  Food. — At  nine  or  ten  months,  a 
healthy,  normal  baby  can  be  allowed  to  munch  a  zwieback 
or  Huntley  and  Palmer's  breakfast  biscuit,  if  he  has  the 
normal  number  of  teeth. 

In  addition,  he  may  be  given,  three  or  four  times  a 
week,  the  outer  mealy  part  of  a  boiled  potato,  finely 
mashed,  taken  from  just  under  the  skin,  not  from  the 
center  where  it  is  hard.  Begin  with  two  teaspoonfuls 
and  gradually  increase  to  one  tablespoon ful  by  the  end 
of  the  year.  It  should  be  flavored  with  a  little  dish  gravy 
or  beef-juice  and  a  pinch  of  salt. 

No  further  additions  to  the  baby's  diet  should  be  al- 
lowed until  after  the  first  year. 

PROTEIN  MILK 

Also  Called  Casein,  Albumin,  Eiweiss  or  Finkelstein's 

Milk 

Protein  milk  is  a  preparation  of  milk  particularly  suit- 
able for  infants  and  younger  children  suffering  from 
diarrhea  with  loose,  undigested  stools. 


64  HOW  TO  TAKE  CARE  OF  THE  BABY 

As  protein  milk  requires  a  great  deal  of  care  and  time 
in  its  preparation,  it  is  advisable,  where  possible,  to  get 
this  milk  from  one  of  the  Walker-Gordon  laboratories, 
or  other  reliable  dairies  which  make  it.  When  not  pos- 
sible to  obtain  it,  it  can  be  made  at  home  as  follows : 

Directions  for  Making. — Take  a  quart  of  whole  milk 
and  warm  it  to  about  100°  F.  Add  one  tablespoonful  of 
essence  of  pepsin  or  liquid  rennet  and  stir  it  up.  Allow 
to  stand  about  one-half  hour  or  until  the  millc  has  cur- 
dled. Then  pour  it  into  a  muslin  bag  or  through  several 
thicknesses  of  cheesecloth  and  strain  off  the  whey.  The 
whey  should  be  thrown  away.  Now  rub  the  curds 
through  a  fine  hair  sieve,  adding  one  pint  of  buttermilk 
to  it  in  doing  so.  When  the  curds  and  buttermilk  have 
been  rubbed  through  the  sieve  add  enough  water  to  the 
mixture  so  that  the  whole  amount  measures  one  quart. 
Place  on  ice  until  wanted. 

Directions  for  Giving. — Protein  milk,  is  given  as 
follows :  for  infants  under  six  months  old,  it  is  at  first 
diluted  with  an  equal  amount  of  water,  later  less  water 
is  added.  Older  children  can  take  this  preparation  un- 
diluted. 

Protein  milk  alone  should  not  be  given  for  more  than 
a  couple  of  weeks.  As  soon  as  the  diarrhea  improves, 
a  small  amount  of  malt  sugar  should  be  added  to  the 
protein  milk.  When  this  agrees,  give  the  child  one  bot- 
tle a  day  with  boiled  skimmed  milk  according  to  his 
age,  then  gradually  increase  the  number  of  these  until 
the  protein  milk  is  no  longer  used.  Slowly  return  to 
whole  milk  formulas  by  taking  off  less  and  less  cream 
from  the  top  of  the  milk  bottle. 

The  protein  milk  should  be  made  from  skimmed  milk, 
when  the  diarrhea  does  not  improve  after  a  few  days, 
or  whenever  there  is  much  vomiting. 


A   MOTHER'S   GUIDE  65 

PEPTONIZED  MILK 

Since  the  introduction  of  protein  milk,  peptonized  milk 
is  seldom  used  for  indigestion  in  infancy,  but  it  is  occa- 
sionally given  to  older  children  during  an  acute  illness. 

Peptonized  milk  undergoes  a  change  by  means  of 
which  the  protein  or  curds  are  partially  or  wholly  pre- 
digested.  Fairchild's  peptonizing  tubes  are  most  com- 
monly used  for  this  purpose,  and  full  directions  come  in 
the  package. 

It  is  more  convenient  to  peptonize  the  entire  day's  sup- 
ply at  once. 

Milk  is  completely  peptonized  by  allowing  the  powder 
to  act  for  two  hours  before  boiling  or  putting  on  ice, 
either  of  which  stops  the  process,  but  the  taste  is  very 
bitter  and  it  is  seldom  used.  As  a  rule  it  should  not  be 
given  for  more  than  a  few  days. 

Partially  peptonized  milk,  in  which  the  milk  has  been 
subjected  to  the  action  of  the  powder  for  ten  or  fifteen 
minutes  only,  is  not  bitter  and  can  be  continued  for  a 
longer  time. 

To  stop  peptonization,  bring  the  milk  to  a  boil,  or  place 
it  on  the  ice. 

BUTTERMILK 

Buttermilk  is  useful  in  many  cases  of  indigestion.  It 
can  be  bought  at  most  large  dairies.  When  not  obtain- 
able it  should  be  made  from  skim  milk,  which  is  fer- 
mented by  means  of  various  tablets  on  the  market,  such 
as  Bulgara,  lactic  acid,  etc.  Directions  come  with  the 
tablets.  Buttermilk  should  be  diluted  with  water  or  bar- 
ley water  for  very  young  infants,  and  should  not  be  used 
for  more  than  a  few  days,  unless  other  foods  are  then 
added. 


66     HOW  TO  TAKE  CARE  OF  THE  BABY 

STERILIZATION  AND  PASTEURIZATION  OF 

MILK 

These  are  the  two  methods  in  vogue  for  heating  milk 
in  order  to  destroy  the  germs  in  it.  All  milk  contains 
germs  to  a  certain  extent,  no  matter  how  carefully  it  is 
handled.  Most  of  the  germs  are  harmless,  but  some  milk 
may  contain  those  of  typhoid  fever,  scarlet  fever,  diph- 
theria, tuberculosis,  cholera  and  diarrhea,  etc. 

Sterilization. — Sterilization  consists  in  boiling  milk 
for  at  least  one  hour  in  a  double  boiler.  It  should  then 
be  rapidly  cooled  by  placing  the  saucepan  in  cold  water, 
which  is  frequently  changed,  or  to  which  ice  has  been 
added,  so  that  the  milk  is  cold  in  about  twenty  minutes. 
Pour  into  bottles  which  have  just  been  boiled,  and  cork 
them  with  sterile  cotton  wool.  They  should  then  be 
placed  on  the  ice  in  the  ice-box. 

This  milk  will  keep  on  ice  for  two  weeks,  and  can 
therefore  be  used  for  long  journeys. 

Stale  or  contaminated  milk  should  never  be  used  as 
food,  and  sterilization  will  not  make  it  fit  for  consump- 
tion. 

Sterilized  milk  is  not  so  palatable  nor  so  digestible  as 
unheated  milk,  and  is  often  liable  to  cause  constipation, 
and  even  scurvy  if  continued  as  the  sole  food  for  several 
months. 

Indications  for  Sterilization. — Sterilization  is  indi- 
cated : 

\.  During  outbreaks  of  diarrhea,  scarlet  fever,  ty- 
phoid fever,  etc. 

2.  When  the  milk  has  to  be  kept  more  than  a  few 
hours  without  ice,  or  when  it  has  to  be  kept  for  more 
than  twenty-four  hours,  as  on  long  journeys. 

Pasteurization. — Pasteurization  consists  in  heating 
milk  at  a  temperature  of  155°  F.  to  160°F.  for  thirty 
minutes.     There  are  several  apparatus  for  this  purpose 


A    MOTHER'S    GUIDE  67 

on  the  market,  the  simplest  being  the  Freeman  pasteur- 
izer. It  is  made  in  two  metals,  tin  and  copper,  which 
cost  four  dollars  and  eight  dollars  respectively.  It  can 
be  obtained  of  J.  T.  Dougherty,  409  West  59th  Street, 
New  York  City,  and  from  most  dealers  in  surgical  in- 
struments.   Directions  for  use  come  in  the  box. 

Indications    for    Pasteurization. — Pasteurization    is 
indicated : 

1.  When  one  is  not  sure  how  the  milk  has  been  han- 
dled, nor  whether  the  cows  are  in  a  healthy  condition. 

2.  In  the  warm  months  of  the  year,  whenever  the 
milk  can  not  be  obtained  fresh,  as  in  towns  and  cities. 


FREEMAN  PASTE»JRIZER 

Pasteurized  milk  should  not  be  kept  for  more  than 
twenty-four  hours. 

When  a  pasteurizer  is  not  obtainable,  the  milk  can  be 
poured  into  bottles  that  have  just  been  boiled,  then  cork 
them  with  sterile  cotton  wool  and  place  them  in  a  tin 
pail.  Fill  the  pail  with  boiling  water,  cover  it  up  and  set 
aside  for  forty  minutes.  Then  cool  rapidly  and  place  on 
the  ice. 

Pasteurized  milk  can  be  used  for  several  months  with- 
out harmful  effects,  but  it  is  preferable  to  use  fresh  milk 
whenever  it  is  obtainable. 

When  in  doubt  about  the  quality  of  the  milk,  especially 


68  HOW  TO  TAKE  CARE  OF  THE  BABY 

in  summer,  it  is  only  necessary  to  bring  it  to  a  boil  to 
make  it  safe.  Boiled  milk  should  not  be  used  over  too 
long  a  period. 

DIET  FROM  ONE  YEAR  TO  FIFTEEN  MONTHS 

6 :30  or  7  a.  m. — Warm  milk,  6  to  8  oz.,  diluted  with 
2  to  3  oz.  of  barley  or  oatmeal  gruel,  given  from  a  cup. 
and  one  zwieback. 

9  a.  m. — Orange  or  prune  juice,  1  to  2  oz.,  given 
with  a  teaspoon. 

10  a.  m. — The  same  as  at  6:30  a.  m. 
2  p.  m. — One  of  the  following: 

a.  The  white  of  one  coddled  egg,  later  the  whole  egg, 
or 

b.  Two  or  three  tablespoonfuls  of  beef-juice,  or 

c.  Mutton  or  chicken  broth,  4  to  6  oz. 

A  little  stale  bread  can  be  broken  up  in  it.  Alternate 
these  on  different  days. 

In  addition  1  to  2  tablespoonfuls  of  boiled  potato,  see 
page  63. 

Warm  milk  diluted  with  34  water,  4  to  6  oz. 

6  p.  m. — The  same  as  at  6 :30  and  10  a.  m. 

10  p.  m. — Seven  to  10  oz.  of  warm  milk  diluted  with 
yi  water,  and  given  from  the  bottle. 

Most  children  should  take  their  meals  from  a  cup  or 
spoon  at  the  age  of  thirteen  or  fourteen  months,  except 
the  10  p.  m.  feeding,  which  should  be  given  from  the 
bottle  so  as  to  disturb  the  child's  sleep  as  Httle  as  possible. 

DIET  FROM  FIFTEEN  TO  EIGHTEEN  MONTHS 
OF  AGE 

Note:  Many  children  even  at  this  age  can  not  take 
undiluted  milk ;  in  that  case  it  should  be  diluted  one-quar- 
ter with  water. 


A   MOTHER'S   GUIDE  69 

6:30  or  7  a.  m. — ^Warm  milk,  8  to  10  oz.,  and  one 
zwieback. 

9  a.  m. — Orange  juice,  or  prune  juice,  2  to  3  oz. 

10  a.  m. — Oatmeal,  hominy,  wheaten  grits,  or  corn- 
meal  cooked  for  at  least  three  hours  and  strained,  or 
cream  of  wheat  cooked  for  half  an  hour,  from  one  to 
three  tablespoonfuls  with  milk  and  a  pinch  of  salt,  but 
no  sugar. 

Also  a  piece  of  dry  toast,  or  a  zwieback  or  one  Hunt- 
ley and  Palmer's  breakfast  biscuit  or  bran  cracker. 
Also  a  cupful  of  warm  milk. 
2  p.  m, — One  of  the  following: 

a.  Beef,  chicken  or  mutton  broth,  4  to  6  oz.,  with  well 
boiled  rice  or  bread  crumbs,  or 

b.  One  soft  boiled  egg  and  1  or  2  oz.  of  beef-juice,  or 

c.  Rare  scraped  beef  3^  to  1  tablespoonful  mixed  with 
beef-juice  or  beef  broth. 

Also  1  to  2  tablespoonfuls  of  boiled  potato,  see  page  63. 

And  in  addition,  2  zwiebacks  or  2  H.  &  P.  breakfast 
biscuits,  or  a  piece  of  cold  crisp  toast  with  a  little  butter 
spread  on  it.    A  drink  of  water,  but  no  milk. 

6  p.  m. — Cream  of  wheat,  farina,  wheatena  or  arrow- 
root cooked  at  least  half  an  hour,  about  2  tablespoonfuls 
with  milk  and  a  pinch  of  salt,  but  no  sugar. 

Also  warm  milk  8  to  9  oz. 

10  p.  m. — Warm  milk  8  to  10  oz.  from  the  bottle. 

DIET   FROM   EIGHTEEN    MONTHS   TO    TWO 
YEARS  OF  AGE 

6:30  or  7  a.  m. — Warm  milk,  10  to  12  oz.,  and  a  zwie- 
back. 

9  a.  m. — Orange  or  prune  juice,  2  to  3  oz. 

10  a.  m. — One  of  the  cereals,  well  cooked  but  not 
strained,  2  or  3  tablespoonfuls,  with  milk.     A  piece  of 


70  HOW  TO  TAKE  CARE  OF  THE  BABY 

crisp  toast  and  butter,  or  zwieback,  or  Huntley  and  Palm- 
er's biscuits,  and  a  cup  of  warm  milk ; 

2  p.  m. — A  cup  of  beef,  mutton  or  cbicken  broth,  or 
2  oz.  of  beef-juice  with  a  little  rice  or  bread  crumbs, 
and  one  of  the  following: 

a.  One  soft  boiled  egg  or  poached  egg. 

b.  A  little  rare  roast  beef,  or  tender  rare  beefsteak, 
scraped  or  minced. 

c.  A  lamb  chop,  or  some  of  the  breast  of  chicken,  cut 
very  fine. 

Two  zwiebacks,  or  stale  bread  with  any  of  the  above. 
Also   1   to  3  tablespoonfuls  of  finely  mashed,  baked 
white  potato  with  a  little  dish  gravy  may  be  given. 
Also  2  tablespoonfuls  of  any  of  the  following  desserts : 

a.  Stewed  prunes  well  cooked  and  strained ;  or 

b.  A  baked  apple  or  apple  sauce ;  or 

c.  Plain  rice  pudding  or  cornstarch,  or  custard  pud- 
ding.    A  drink  of  water,  but  no  milk. 

6  p.  m. — a.  Cream  of  wheat,  farina  or  arrowroot, 
with  a  little  cream  and  a  pinch  of  salt ;  or 

b.  Milk  toast;  or 

c.  Zwieback  soaked  in  warm  milk. 

Also  a  cup  of  milk  with  any  of  the  above. 
10  p.  m. — A  drink  of  milk  for  those  children  who 
do  not  sleep  from  6  p.  m.  to  6  a.  m. 

DIET  FROM  TWO  TO  THREE  YEARS  OF  AGE 

7:30  a.  m. — Cereals,  as  before,  and  an  egg,  boiled 
or  poached.  One  glass  of  milk  and  stale  bread,  or  zwie- 
back, or  Huntley  and  Palmer's  biscuits. 

10  a.  m. — One  cup  of  milk  and  a  cracker. 

1 :30  or  2  p.  m. — A  cupful  of  broth  or  2  oz.  of  beef 
juice  and  one  of  the  following:  beefsteak,  chop,  roast 
beef,  lamb,  or  chicken,  with  dish  grav>',  and  a  baked 
white  mashed  potato,  or  well  cooked  rice,  or  spaghetti 


A   MOTHER'S   GUIDE  71 

and  one  of  the  following  vegetables :  green  peas,  string 
beans,  cauliflower,  boiled  tomatoes,  carrots,  spinach,  as- 
paragus tips,  all  cooked  soft  and  mashed,  and  begun  in 
very  small  quantities.  Also  one  of  the  following  des- 
serts :  baked  apple,  apple  sauce,  stewed  prunes,  rice  pud- 
ding, junket,  bread  pudding,  custard,  cornstarch.  Water 
to  drink,  no  milk. 

6  p.  m. — Cereals  and  milk  with  crackers  or  stale 
bread,  or  milk  toast,  or  bread  and  milk. 

A  drink  of  water  should  be  offered  two  or  three  times 
between  meals,  but  a  large  amount  at  meal-time  must 
not  be  given  ;  about  half  a  glassful  is  sufficient. 

DIET  LIST  FROM  THE  FOURTH  TO  THE 
TENTH  YEAR 

Breakfast,  7:30  or  8  a.  m. — A  choice  of  one  of  the 
cereals,  cooked  for  three  hours,  and  served  with  milk 
and  a  pinch  of  salt,  but  very  little  cream,  and  no  sugar. 

Stale  bread  and  butter  or  zwieback,  graham  crackers, 
oatmeal  crackers,  or  Huntley  and  Palmer's  breakfast  bis- 
cuits, or  stale  rolls. 

A  soft-boiled,  poached  or  coddled  egg. 

A  little  apple  sauce,  or  a  baked  apple,  or  prune  pulp. 

A  glass  of  warm  milk. 

Dinner,  12:30  or  1  p.  m. — Chicken,  beef,  or  mutton 
broth,  with  rice  or  barley.  After  the  age  of  seven,  veg- 
etable puree  soups  may  be  given. 

A  choice  of  white  fish,  flounders,  shad  or  bass,  or  roast 
lamb,  beef  or  chicken  or  lamb  chop  or  beefsteak. 

With  the  meals,  only  the  dish  gravy  should  be  allowed, 
and  baked  or  boiled  white  potatoes  mashed  up  and  mixed 
with  it. 

Of  the  vegetables,  a  choice  can  be  made  of  spinach, 
green  peas,  asparagus  tips,  cauliflower,  carrots,  stewed 
celery,  beets,  string  beans,  squash,  lima  beans,  and  after 


72  HOW  TO  TAKE  CARE  OF  THE  BABY 

six  years  of  age,  turnips,  sweet  potatoes,  and  boiled 
onions. 

For  dessert,  a  choice  of  custard,  junket,  rice  pudding 
without  raisins,  any  plain  milk  pudding,  or  apple  sauce, 
baked  apple,  or  stewed  prunes,  peaches  or  pears,  and  oc- 
casionally, a  little  ice-cream. 

Only  water  should  be  given  to  drink  at  this  meal. 

Supper,  6  p.  m. — Milk  toast  and  milk,  or  cereal  and 
milk,  and  stale  bread  or  zwieback  or  Huntley  and  Palm- 
er's breakfast  biscuits.  Sometimes  cocoa  can  replace  the 
glass  of  milk,  but  it  must  not  be  made  rich. 

Three  Meals  a  Day. — After  the  third  year  three 
meals  a  day  are  sufficient,  except  that  a  glass  of  milk  and 
a  cracker  may  still  be  given  between  breakfast  and  lunch 
if  a  child  is  hungry  and  the  practice  does  not  lessen  his 
appetite  for  the  midday  meal,  which  should  be  the  prin- 
cipal one  of  the  day. 

Regular  Hours  for  Meals. — The  meals  ought  to  be 
at  regular  hours,  and  any  eating  between  them,  with  the 
above  exception,  must  be  strictly  forbidden.  Water, 
however,  can  be  given  in  abundance  between  meals  when- 
ever the  child  is  thirsty,  but  not  more  than  a  glassful 
should  be  taken  at  meal-time. 

Milk. — Milk  is  still  a  very  important  item  in  a  child's 
diet,  and  a  healthy  child  will  consume  about  one  and  a 
half  pints  a  day,  including  what  is  served  with  cereals, 
in  puddings,  etc.  It  often  happens  that  the  milk  a  child 
drinks  is  better  digested  if  it  is  still  a  little  diluted,  about 
one- fourth  part  water.  Too  much  rich  milk  or  cream 
is  apt  to  produce  loss  of  appetite  and  foul  breath. 

Fruits. — Sour  fruits  of  any  kind  should  not  be 
given  at  the  same  meal  with  milk,  as  they  will  cause  it 
to  curdle. 

Fresh  fruit  juice  early  in  the  morning  has  a  very  bene- 
ficial effect  on  the  bowels ;  and  small  quantities  of  peeled 
pears,  peaches,  and  apples  or  a  few  fresh  berries  can  be 


A   MOTHER'S   GUIDE  73. 

given  at  meal-time,  but  care  must  be  exercised,  especially 
in  hot  weather. 

Importance  of  Mastication  and  Thorough  Cooking. 
— Teach  children  to  chew  their  food  very  thoroughly, 
and  to  eat  slowly.  As  they  are  invariably  careless  in 
this  respect,  it  is  very  important  that  all  their  meats 
should  be  cut  in  very  small  pieces,  and  the  vegetables 
cooked  until  very  soft,  and  mashed  in  addition.  Cereals, 
also,  should  be  cooked  for  a  very  much  longer  time  than 
stated  in  the  directions  on  the  package.  Although  they 
are  a  useful  part  of  a  child's  diet,  he  must  not  be  allowed 
to  eat  them  in  excess,  and  the  ready  cooked  cereals 
should  not  be  given. 

Importance  of  Pure  Foods. — Only  the  purest  foods 
should  be  eaten.  Whole  wheat  bread  is  the  only  kind 
to  buy  or  bake.  For  a  full  description  of  unwholesome 
foods  used  in  most  families  the  reader  is  requested  to 
read  Starving  America,  by  Alfred  W.  McCann,  pub- 
lished by  the  George  H.  Doran  Company,  New  York. 

LOSS  OF  APPETITE 

The  most  frequent  causes  of  loss  of  appetite  in  chil- 
dren are  enumerated  below. 

Causes. — 1.  Sprue  or  thrush  or  any  other  painful 
condition  in  the  mouth  or  throat  causes  so  much  discom- 
fort to  a  child  that  he  will  not  take  his  bottle.  His  re- 
fusal is  wrongly  attributed  to  loss  of  appetite.  (For 
treatment  see  page  110.) 

2.  Eating  between  meals ;  a  few  crackers  or  a  little 
milk  will  often  take  away  the  appetite  for  the  next  meal. 

3.  Too  frequent  feedings  or  too  many  meals  during 
the  day,  i.  e.,  the  giving  of  food  before  the  last  meal  has 
had  time  to  digest. 

4.  Eating  forbidden  articles  of  food  or  unsuitable 
food,  such  as  pastry,  cake,  candy,  etc. 


74  HOW  TO  TAKE  CARE  OF  THE  BABY 

5.  Exclusive  milk  diet  in  children  over  a  year  old  and 
who  refuse  to  take  anything  else  but  the  bottle,  or  too 
large  a  quantity  of  any  one  food,  as  cereal,  etc.  This 
condition  is  difficult  to  set  right,  for  milk  alone  is  not 
an  adequate  food  at  this  age  and  the  child  becomes 
anemic,  nervous  and  restless  in  consequence.  This  can 
sometimes  be  remedied  in  the  following  manner,  i.  e., 
dilute  the  milk  with  an  equal  quantity  of  water  and  give 
the  usual  amount.  Next  day,  if  the  child  still  refuses 
to  take  other  food,  dilute  the  milk  still  more,  viz.,  one- 
fourth  milk  and  three-fourths  water.  Very  soon  the 
child  will  become  so  hungry  that  he  will  be  glad  to  take 
anything  offered  him. 

Older  children  should  not  begin  a  meal  by  drinking 
one  or  two  glasses  of  milk, — they  should  take  it  after 
the  meal,  but  they  can  have  all  the  water  they  want. 

6.  Too  rich  milk  or  too  much  cream  is  a  frequent 
cause  of  loss  of  appetite  often  accompanied  by  a  coated 
tongue  and  foul  breath.  Cream  is  quite  unnecessary  for 
children,  excepting  once  a  week  in  ice-cream,  etc.  Most 
children  do  better  on  three  parts  ordinary  four  per  cent, 
milk  and  one  part  water,  and  when  they  require  more 
nourishment,  it  should  be  supplemented  by  other  foods. 

Too  rich  milk  or  cream  in  addition  to  causing  loss  of 
appetite  is  sometimes  responsible  for  congestion  of  the 
liver,  manifested  by  obscure  abdominal  pains,  extreme 
irritability  and  light  colored  stools. 

In  one  of  my  cases,  a  boy  five  years  old  was  "doubled 
up,"  had  no  appetite  and  complained  of  pain  in  the  abdo- 
men, and  this  condition  had  been  diagnosed  as  appendi- 
citis. It  appeared,  however,  that  he  had  returned  from 
a  farm  the  day  before,  where  he  had  been  allowed  all 
the  rich  milk  and  cream  he  wanted  for  two  weeks.  On 
stopping  all  cream  and  milk,  the  symptoms  promptly  dis- 
appeared. 

7.  Habitual  constipation, — for  treatment  see  page  97 


A   MOTHER'S   GUIDE  75 

8.  Cold  baths,  with  the  desire  to  harden  the  child,  are 
sometimes  the  cause  of  loss  of  appetite,  accompanied  by- 
symptoms  of  congestion  of  the  liver.  (See  No.  6  above.) 
If  a  child  does  not  feel  warm  and  glowing  after  a  cold 
bath,  but  shivers,  has  cold  hands  and  feet  and  blue  lips, 
it  shows  plainly  that  the  cold  water  does  not  agree  with 
him. 

A  boy,  seven  years  old,  had  had  abdominal  pains,  poor 
appetite  and  light  colored  stools  for  several  months,  when 
I  was  called  in  to  see  him.  On  inquiry,  I  found  that 
he  had  been  given  cold  baths  to  harden  him.  He  felt 
cold  for  an  hour  or  more  after  the  bath.  After  substi- 
tuting hot  baths,  he  had  no  return  of  the  symptoms. 

9.  Insufficient  outdoor  exercise  and  want  of  fresh  air 
in  the  rooms,  especially  at  night.  Most  rooms  are  kept 
too  hot  and  are  not  properly  ventilated. 

10.  Large  adenoids  and  tonsils  of  long  standing  cause 
anemia  with  loss  of  appetite. 

11.  The  onset  of  any  severe  illness  will  usually  begin 
by  loss  of  appetite. 

12.  There  is  a  fairly  common  type  of  loss  of  appetite 
without  apparent  cause.  It  may  occur  during  infancy 
but  is  more  usual  after  two  years  of  age.  The  history 
is  somewhat  as  follows :  The  mother  notices  that  the  child 
does  not  take  his  food  so  eagerly  as  usual,  and  urges  him 
to  eat.  The  child  becomes  more  and  more  unwilling  so 
that  the  mother,  in  her  anxiety,  resorts  to  various  devices 
such  as  singing  and  telling  stories  to  distract  the  child's 
attention,  pretending  to  feed  other  members  of  the  fam- 
ily, dolls,  etc.,  in  order  to  induce  him  to  take  his  meals. 

This  procedure  is,  no  doubt,  familiar  to  many,  as  is 
likewise  the  inevitable  result.  The  child  goes  on  a  com- 
plete hunger  strike,  and  is  nervously  upset,  while  the 
mother  is  in  despair.  The  only  solution  to  this  trying 
problem  is  to  let  the  child  severely  alone.  If  he  is  over 
two  years  of  age,  give  only  three  meals  a  day.    Put  all 


76     HOW  TO  TAKE  CARE  OF  THE  BABY 

the  food  for  the  meal  on  a  tray, — for  example,  a  sample 
breakfast  would  be  two  tablespoonfuls  of  cooked  cereal 
with  two  ounces  of  milk  poured  on  it,  six  ounces  of  milk 
in  a  glass,  and  a  slice  of  bread  and  butter.  The  baby 
is  first  offered  a  teaspoonful  of  cereal  and  pushes  it  away. 
The  cereal  is  at  once  removed  from  the  table  without  a 
word  being  spoken.  Next  the  baby  is  offered  a  drink 
of  milk,  this  also  is  refused  and  taken  away.  The  same 
may  happen  with  the  bread  and  butter.  The  child  may 
not  have  eaten  a  mouthful,  but  the  mother  should  take 
off  his  napkin  and  let  him  down  from  the  table  without 
a  word  being  spoken.  It  is  very  likely  that  the  child 
will  ask  for  food  shortly  afterward.  He  must  be  sternly 
refused  without  arguing.  He  may,  however,  have  all  the 
water  he  cares  to  drink.  The  same  procedure  should  be 
followed  at  dinner  and  supper.  A  child  can  safely  go 
five  or  six  days  without  food.  However,  it  almost  in- 
variably happens  that  in  two  or  three  days  he  will  take 
his  food  ravenously. 

With  some  children  it  may  be  necessary  to  lengthen 
the  intervals  between  feedings.  If  the  tongue  is  coated 
and  the  breath  is  foul,  it  is  advisable  to  give  a  brisk  ca- 
thartic and  to  offer  less  food  at  the  next  meal. 

In  summer  time,  especially,  less  food,  particularly 
meat,  is  required  by  a  child,  but  he  needs  more  water 
between  meals. 

Supper  should  always  be  a  light  meal,  as  otherwise  a 
child's  sleep  may  be  disturbed. 

Peculiarities  of  Appetite. — Children  often  develop 
a  habit  of  eating  too  much  of  some  one  article  of  food, 
to  the  exclusion  of  others.  In  some  it  may  be  meat,  in 
some  cereals,  in  others  vegetables,  and  a  few  will  take 
so  much  milk  that  they  have  no  appetite  for  anything 
else.  While  all  these  foods  are  excellent  in  their  way,  a 
child  will  thrive  much  better  on  a  mixed  diet.  In  order 
to  teach  him  to  eat  what  is  good  for  him,  it  may  be  ad- 


A   MOTHER'S   GUIDE  17 

visable  to  withhold  the  desired  food  altogether  for  a  few 
days,  and,  if  necessary,  to  starve  him  a  little,  and  begin 
feeding  by  serving  him  with  whatever  food  he  usually 
refuses. 

FORBIDDEN  ARTICLES  OF  FOOD 

All  fried  food  of  any  kind,  except  bacon  and  the  juice 
of  bacon. 

Fish. — All  fish  not  mentioned  in  diet  list,  and  all  salt 
fish. 

Meats. — Pork,  ham,  veal,  kidney,  liver,  rich  stews, 
duck  or  goose  and  all  prepared  meats,  such  as  sausage 
or  salted  meat. 

Vegetables. — Cabbage,  corn,  fried  egg-plant  or  onions, 
or  raw  vegetables,  or  salads  of  any  description. 

Bread. — Fresh  bread,  hot  bread,  muffins,  hot  biscuits, 
doughnuts,  griddle  or  buckwheat  cakes,  or  fresh  sweet 
cakes  of  any  kind. 

Desserts. — Nuts,  pastry,  candy,  rich  puddings  or  pre- 
serves, dried  fruits,  or  pies. 

Fruits. — Pineapple,  the  pulp  of  grapefruit  or  oranges, 
cherries,  grapes,  unless  the  skins  and  seeds  are  removed, 
berries,  unless  very  fresh,  and  then  only  a  limited  quan- 
tity. 

Beverages. — Tea,  cofifee,  beer,  wine,  or  cider,  should 
be  absolutely  forbidden  until  a  child  is  fifteen  or  six- 
teen years  of  age,  and  lemonade  or  soda  water  only 
very  sparingly  allowed. 

STOOLS 

Normal  Stools. — During  the  first  week  a  healthy 
breast-fed  baby  should  have  four  or  five  stools  a  day. 
For  the  first  three  or  four  days,  they  are  dark  brown 
with  a  tinge  of  green,  and  pasty  in  consistency.     They 


78  HOW  TO  TAKE  CARE  OF  THE  BABY 

gradually  become  lighter,  until  by  the  end  of  the  first 
week,  they  are  of  a  light  yellow  mustard  color,  soft  and 
pasty,  and  with  a  slightly  acid  odor.  After  the  first  week 
a  breast-fed  baby  has  from  two  to  four  stools  a  day. 

A  healthy,  bottle-fed  baby  has  but  one  or  two  stools 
a  day,  and  these  are  of  a  paler  yellow,  firmer,  larger, 
and  more  granular.  The  odor  is  more  pungent,  and 
may  be  cheesy,  or  foul. 

Proprietary  Foods. — After  the  use  of  proprietary 
foods,  the  color  of  the  stools  changes  to  a  light  gray  or 
light  brown. 

Drugs. — Iron  and  bismuth  change  the  stools  to  a 
tiark,  almost  black  color. 

When  calomel  is  given  in  effective  doses,  the  first  por- 
tion of  the  stool  that  is  expelled  may  be  normal,  but  the 
last  portion  is  loose  and  green.  This  is  directly  due  to 
the  action  of  the  drug. 

Curds  in  the  Stools. — ^^'hen  either  the  fat  or  the 
protein  is  not  j^roperly  digested,  it  will  appear  in  the  stool 
in  the  form  of  curds,  or  whitish  round  or  oblong  lumps 
of  various  sizes. 

Fat  curds  are  small,  soft,  white  or  yellowish  lumps, 
about  the  size  of  a  pin's  head,  or  a  little  larger.  Pro- 
tein curds  are  hard,  white  or  yellowish,  shiny,  round  or 
oblong  lumps  from  the  size  of  a  small  pea  to  a  fair  sized 
bean. 

If  the  curd  is  put  on  a  board  and  pressed  with  a  piece 
of  wood,  a  fat  curd  will  flatten  out  easily,  while  a  pro- 
tein curd  requires  some  pressure. 

Stools  Showing  Excess  of  Fat. — If  the  trouble  is 
excess  of  fat,  the  stools  will  generally  be  loose  and  grass 
or  light-green,  or,  rarely,  pale  gray  and  in  small  dry 
lumps,  or  large,  pasty  and  greasy,  with  a  very  rancid 
odor. 

Protein  Curds. — Large  and  hard  white  or  yellowish 
curds,  formerly  considered  due  to  faulty  digestion  of  the 


A   MOTHER'S    GUIDE  79 

protein,  are  now  considered  the  result  of  milk  that  is  too 
rich  in  cream.    When  boiled  milk  is  used,  they  disappear. 

Stools  Showing  Excess  of  Sugar. — Frequent  loose, 
green  stools,  sometimes  frothy,  and  with  an  offensive, 
sour  and  pungent  odor,  and  with  much  gas,  are  caused 
by  excess  of  sugar,  or  proprietary  foods,  which  all  con- 
tain large  amounts  of  sugar.  When  this  condition  lasts 
for  a  few  days  the  buttocks  become  red  and  sore. 

Stools  from  Overfeeding. — Infants  who  are  overfed 
may  have  four  or  five  normal  stools  daily,  often  immedi- 
ately after  feeding;  or  they  may  be  more  numerous,  from 
four  to  seven  a  day,  and  fairly  well  digested,  but  contain- 
ing a  large  amount  of  mucus.  On  the  other  hand,  some 
children  who  are  overfed  will  only  have  one  stool  a  day, 
and  this  will  be  large,  light-colored  and  pasty,  with  a  foul 
odor. 

Inactive  Liver. — Pale,  almost  white,  pasty  stools 
show  inactivity  of  the  liver.  A  good  dose  of  calomel 
and  attention  to  the  diet  will  remedy  this  condition.  (See 
chapter  on  Loss  of  Appetite.)  ^ 

Inflammation  of  the  Bowels. — The  stools  will  be 
loose,  grass-green  in  color  and  contain  mucus.  This  con- 
dition should  be  treated  as  a  case  of  severe  diarrhea. 

Blood  in  Stools. — Blood  in  the  stools,  except  when 
constipated,  is  always  a  sign  of  a  serious  condition,  which 
should  be  promptly  attended  to  by  a  physician. 

Indigestion. — In  nearly  all  severe  forms  of  indiges- 
tion, we  find  loose,  green  stools  containing  curds  and 
mucus,  and  with  a  foul  odor,  so  that  it  is  often  very  diffi- 
cult to  know  where  to  place  the  blame.  In  making  a  diag- 
nosis, a  child's  other  symptoms  must  be  taken  into  con- 
sideration as  well  as  the  character  of  the  stools.  (See 
chapter  on  Indigestion.)  In  many  cases,  no  absolute 
diagnosis  is  possible,  without  a  careful  laboratory  exam- 
ination. 

Stools  that  are  granular  with  some  curds'  and  some 


80  HOW  TO  TAKE  CARE  OF  THE  BABY 

mucus  are  not  unfavorable  if  the  child   is  gaining  in 
weight. 

The  feeding  should  be  made  weaker  or  changed  when 
the  stools  are — 

1.  More  than  five  a  day. 

2.  Very  green. 

3.  Very  foul  smelling. 

4.  Accompanied  by  much  gas. 

Bright  green,  watery  stools  or  stools  with  a  large 
amount  of  mucus  should  be  treated  as  a  case  of  severe 
diarrhea. 

Brick  Red  Discoloration. — Normal  stools  with  a 
brick-red  discoloration  on  the  napkins  signify  that  the 
child  requires  more  fluid,  especially  water.  This  dis- 
coloration will  disappear  in  a  few  hours  after  plenty  of 
water  has  been  taken  by  the  child. 

INDIGESTION 

As  a  child  thrives  and  gains  in  weight  only  when  his 
food  is  properly  digested,  any  symptoms  showing  de- 
rangement of  the  digestion  must  receive  prompt  atten- 
tion, and  the  cause  be  rectified. 

Causes. — There  are  many  causes  for  indigestion, 
most  of  which  are  avoidable.  The  most  common  are : 
eating  too  rapidly,  eating  between  meals,  too  frequent 
meals,  coaxing  a  child  to  eat  when  he  is  not  hungry,  giv- 
ing only  those  articles  of  food  which  a  child  craves, 
too  much  cake  or  candy,  raw  or  stale  fruits,  insufficiently 
cooked  foods,  unsuitable  foods,  etc. 

Symptoms. — Children  suffering  from  indigestion 
show  it  in  many  ways.  They  do  not  sleep  well,  they  are 
languid,  fretful  or  irritable,  lose  their  appetite,  do  not 
gain  in  weight  and  look  pale.  The  breath  is  foul,  the 
tongue  is  coated,  the  bowels  are  not  normal  and  they 
complain  of  pains  in  the  head  and  stomach. 


A   MOTHER'S   GUIDE  81 

Treatment. — The  bowels  must  always  be  emptied 
by  a  cathartic,  calomel  if  the  child  is  constipated,  or  cas- 
tor oil  if  he  has  diarrhea. 

In  nursing  infants,  the  further  treatment  of  indiges- 
tion due  to  any  cause  not  connected  with  the  mother's 
milk  is  explained  in  the  chapter  on  Diarrhea. 

Feeding  During  Illness. — In  the  case  of  a  bottle-fed 
baby,  the  food  must  never  be  given  full  strength  when 
he  is  not  in  his  usual  health.  For  a  slight  indisposition, 
the  milk  should  be  diluted  by  pouring  off  one-fourth  to 
one-half  of  the  mixture,  and  substituting  the  same 
amount  of  boiled  water.  Feed  less  frequently,  but  give 
plenty  of  water  to  drink  between  meals.  In  a  case  of 
acute  indigestion,  all  milk  should  be  stopped  for  twenty- 
four  hours,  and  barley  water  or  whey  given  instead.  On 
recovery,  begin  feeding  on  a  low  formula,  and,  at  first, 
use  boiled  skimmed  milk  or  partially  peptonized  milk. 

Feeding  After  Illness. — Great  care  must  be  exercised 
in  returning  to  the  original  formula  after  an  illness,  as 
when  an  infant  is  once  seriously  upset,  he  is  much  more 
liable  to  similar  attacks  in  the  future,  and  these  from 
slighter  causes.  After  any  acute  indigestion,  food  should 
be  very  carefully  increased  so  that  the  original  strength 
will  not  be  reached  until  after  ten  or  fourteen  days. 

Indigestion  Caused  by  Overfeeding. — Overfeeding 
is  a  frequent  cause  of  indigestion  in  bottle-fed  infants, 
and  is  often  brought  on  by  the  mother's  desire  for  the 
child  to  gain  rapidly  in  weight.  It  should  be  remem- 
bered that  a  child  is  capable  of  digesting  only  a  certain 
amount  of  food,  and  gains  only  when  that  is  properly  di- 
gested. Any  excess  is  harmful,  because  it  remains  undi- 
gested, and  will  only  ferment  and  cause  trouble.  Overfed 
and  excessively  fat  babies  are  usually  delicate,  and  are 
easily  upset  from  slight  causes. 

Symptoms. — A  child  who  has  been  overfed  becomes 
restless,  fretful  and  appears  uncomfortable.     He  sleeps 


82  HOW  TO  TAKE  CARE  OF  THE  BABY 

badly,  stops  gaming  or  loses  in  weight,  vomits  after 
feeding,  suflfers  from  colic  and  wind,  and  his  stools  are 
abnormal.  He  always  seems  hungry,  especially  at  night, 
and  for  this  reason  more  and  more  food  is  given,  thereby 
making  the  condition  worse.  An  infant  habitually  over- 
fed has  a  large  abdomen  or  "pot  belly,"  and  often  suf- 
fers from  rickets. 

Treatment. — In  these  cases,  simply  reducing  the 
food,  giving  an  amount  suitable  to  the  vv-eight  (see  sched- 
ule, page  54)  and  lengthening  the  intervals,  will  often  be 
the  only  treatment  necessary. 

Indigestion  from  Improperly  Proportioned  Food. — 
The  digestive  capabilities  of  infants  vary  so  much  that 
although  the  formula  suited  to  the  age,  weight  and  condi- 
tion is  given,  one  or  the  other  ingredients  may  not  suit  a 
particular  child.  The  amounts  of  fat,  sugar  and  protein 
may  not  be  excessive,  but  the  child's  symptoms  will  show 
that  he  is  not  digesting  it.  When  this  happens,  a  change 
in  the  food  must  be  made. 

Indigestion  from  Excess  of  Fat. — The  excess  of  fat 
may  upset  the  stomach  or  the  bowels,  or  both.  When- 
ever the  stomach  is  disturbed  the  child  will  vomit.  But 
if  the  bowels  can  not  handle  the  amount  of  fat,  then  the 
stools  may  be  loose  and  green  with  curds  and  mucus ; 
or  large,  fatty  and  rancid ;  or  small,  dry  and  lumpy.  In 
any  case  the  child  does  not  gain  in  weight  and  may  lose 
flesh,  although  the  increase  may  have  been  rapid  pre- 
viously. 

Treatment. — Make  up  formulas  with  skimmed  milk 
and  if  there  is  no  improvement  in  a  day  or  two,  boil  the 
milk.  If  there  is  much  gas,  give  half  the  amount  of  sugar, 
or  leave  it  out  altogether.  If  the  symptoms  are  not  bet- 
ter in  a  few  days,  give  buttermilk  or  protein  milk. 

Indigestion  from  Excessive  Protein. — Recent  inves- 
tigations and  experiments  have  shown  that  indigestion 


A   MOTHER'S   GUIDE  83 

from  protein  in  the  ordinary  milk  modifications  is  a  myth, 
and  the  fault  should  be  pi  t  on  the  cream  or  sugar.  When 
there  are  many  curds  in  the  stools,  the  milk  should  be 
boiled. 

Indigestion  from  Excess  of  Sugar. — Too  much 
sugar,  or  proprietary  foods,  which  all  contain  large 
amounts  of  sugar,  are  sometimes  the  cause  of  trouble. 
The  child  has  loose,  green,  sometimes  frothy,  sour,  or 
pungent  stools,  and  may  suffer  from  flatulence  and  sore 
buttocks. 

Treatment. — Use  half  the  amount  or  less  of  milk 
sugar  given  in  the  formula  until  the  symptoms  have  im- 
proved. 

Chronic  Indigestion. — Indigestion  in  bottle-fed  in- 
fants sometimes  persists  in  spite  of  all  changes  in  the 
milk,  and  strict  attention  to  all  details  connected  with 
the  feeding.  When  this  condition  becomes  chronic,  it 
is  necessary  to  make  some  radical  change  in  the  food.  A 
wet-nurse  will  often  be  the  means  of  a  satisfactory  solu- 
tion of  this  problem.  When  this  is  not  possible,  the  use 
of  protein  milk  or  buttermilk  for  a  few  days  will  some- 
times help  in  restoring  a  child's  digestion  to  its  normal 
condition. 

Protein  Milk. — This  preparation  should  be  used  in 
all  cases  in  which  the  food  is  not  properly  digested  and 
the  stools  are  loose  and  foul  with  curds  and  mucus,  and 
after  boiled  skimrned  milk  and  other  modifications  have 
been  tried  without  success.     (See  protein  milk,  page  63.) 

Mammala. — A  dessicated  milk  known  as  Mammala 
can  be  used  in  some  cases  of  indigestion  where  the  ordi- 
nary milk  does  not  agree.    Directions  come  with  the  tin. 

Condensed  Milk  and  Patent  Foods. — There  are  some 
cases  where  the  use  of  condensed  milk  or  some  patent 
food  will  succeed  for  a  short  time  when  all  other  forms 
of  feeding  have  failed.    Notwithstanding  their  undoubted 


84  HOW  TO  TAKE  CARE  OF  THE  BABY 

temporary  value  in  many  apparently  hopeless  cases,  if 
they  are  used  for  too  long  a  time,  rickets  or  scurvy  may 
result. 

Sweetened  and  Unsweetened  Condensed  Milk.— 
Condensed  milk  is  especially  useful  when  a  child  has 
intestinal  symptoms,  colic  and  wind.  It  should,  how- 
ever, not  be  continued  longer  than  two  or  three  weeks. 
By  that  time  the  child  should  begin  again  on  a  weak  fresh 
milk  formula.  When  the  sweetened  condensed  milk  is 
used,  Borden's  Eagle  Brand  is  recommended,  begin- 
ning with  one  part  of  condensed  milk  to  fifteen  parts 
of  boiled  water  for  a  child  three  months  old,  and  grad- 
ually increasing  to  about  one  part  milk  to  eight  parts 
water ;  or  one  teaspoon ful  poured  out  from  the  can  into 
the  spoon  and  mixed  with  four  ounces  of  water  at  first, 
and  the  strength  of  this  mixture  gradually  increased  by 
taking  less  and  less  water  until  only  two  ounces  of  water 
are  required  to  one  teaspoonful  of  condensed  milk.  Do 
not  use  less  water  as  the  proportion  of  sugar  will  be  too 
high  in  the  mixture.  The  milk  should  not  be  taken  out 
of  the  can  with  the  spoon,  as  the  amount  removed  in  this 
way  varies  with  the  skill  of  the  operator,  and  is  far  from 
accurate. 

With  the  unsweetened  brand  one  does  not  run  the  risk 
of  giving  too  much  sugar,  but  it  must  be  used  within  two 
days  after  opening  the  tin,  as  it  does  not  keep  so  well. 
One  teaspoonful  poured  from  the  can  and  mixed  with  two 
ounces  of  water  is  the  full  strength,  and  should  not  be 
exceeded.  H  half  a  teaspoonful  of  milk  sugar  is  added 
to  every  three  ounces  of  this  mixture  the  proportions  of 
the  whole  will  be  suitable  for  a  child  three  to  six  months 
old. 

Patented  Foods. — Mellin's  food,  Borden's  malted 
milk,  or  Horlick's  malted  milk,  being  free  from  starch, 
can  be  given  at  any  age  when  the  child  is  constipated, 
does  not  vomit  and  is  not  gaining  as  he  should.    For  di- 


A   MOTHER'S   GUIDE  85 

rections,  see  page  52.  Starchy  foods,  with  the  excep- 
tion of  barley  water  (mentioned  on  page  55)  should  not 
be  given  until  a  child  is  over  three  months  old.  After 
this  age,  some  of  the  patent  infant  foods  containing 
starch,  such  as  Eskay's,  Nestle's,  Imperial  Granum,  etc., 
can  be  used  for  a  short  time  with  advantage  in  some 
cases. 

COLIC  AND  WIND 

Causes. — In  a  nursing  baby  colic  is  due  to  too  fre- 
quent nursing,  overfeeding,  or  too  rich  milk.  (See 
chapter  on  Nursing.) 

In  bottle-fed  babies,  the  chief  causes  are  overfeeding 
or  the  giving  of  indigestible  food,  especially  sugar  and 
starchy  foods.  Constipation,  cold  feet  and  giving  cold 
food  also  cause  colic. 

Symptoms. — The  child  cries,  draws  up  its  legs,  and 
gives  evidences  of  distress.  The  stomach  is  hard  and 
distended,  the  hands  and  feet  may  be  cold,  and  the  face 
pale.  Rumbling  sounds  can  sometimes  be  heard  in  the 
bowels. 

Treatment. — In  mild  cases,  the  stomach  should  be 
gently  rubbed  for  a  few  minutes,  or  the  child  made  to 
lie  on  its  stomach  on  the  mother's  lap,  and  the  back  patted 
with  the  palm  of  the  hand.  A  hot  water  bottle  to  the 
stomach  is  very  soothing,  and  the  administration  of  a  half 
teaspoon ful  of  peppermint  water  mixed  with  a  little  hot 
water  will  often  be  followed  by  an  eructation  of  gas, 
which  will  give  great  relief. 

If  the  bowels  are  loose,  a  good  dose  of  castor  oil,  fol- 
lowed by  the  application  of  hot  compresses  to  the  abdo- 
men will  soon  relieve  the  symptoms.  In  severe  or  neg- 
lected cases,  a  hot  saline  colon  irrigation  should  be  given. 

If  the  bowels  are  costive,  give  calomel  followed  by 
mild  laxatives,  and  see  that  the  bowels  move  regularly. 

In  sudden  acute  cases  of  colic,  the  food  should  be 


86  HOW  TO  TAKE  CARE  OF  THE  BABY 

greatly  diluted  for  the  next  twenty-four  hours.  In 
chronic  cases,  feed  the  child  on  boiled  skimmed  milk  or 
partially  peptonized  milk  for  a  few  days,  then  give  a 
weaker  whole  milk  formula  than  before  the  attack. 

VOMITING 

Vomiting  in  infants  is  due  to  so  many  causes,  that  for 
the  sake  of  convenience  I  shall  discuss  it  under  different 
headings,  and  begin  with  the  most  common  causes,  as 
follows : 

A. — 1.    Overfeeding. 

2.  Too  rapid  feeding. 

3.  Too  frequent  feeding. 

4.  Handling  or  playing  with  a  baby  after  feeding. 

5.  Tight  abdominal  binder. 

B. — Other  causes  due  to  the  excess  of  some  ingredient 
in  the  milk. 

1.  Excess  of  fat  (a  very  common  cause). 

2.  Excess  of  sugar. 

C. — Vomiting  may  be  the  result  of : 

1.  Acute   indigestion    (catching  cold). 

2.  Chronic  constipation. 

3.  Habit.^ 

D. — Vomiting  is  often  brought  on  in  bottle-fed  infants 
by: 

1.  Indigestible  food. 

2.  Stale  food. 

3.  Too  strong  a  food  on  first  trial. 

4.  Too  frequent  changes  in  the  food. 

E. — Vomiting  occurs  at  the  onset  of  certain  diseases 
and  from  some  abnormal  conditions. 

Nursing  and  Bottle-Fed  Infants. — With  the  excep- 
tion of  the  causes  mentioned  under  the  heading  D,  these 
conditions  may  exist  in  both  the  breast-fed  and  the  bottle- 
fed.    The  chapter  on  Nursing  includes  overfeeding,  too 


A   MOTHER'S   GUIDE  217, 

rapid  feeding,  too  frequent  feeding,  also  excess  of  fat 
in  the  mother's  milk;  and  the  details  of  treatment  are 
there  explained.  Excess  of  sugar  in  the  mother's  milk 
during  the  last  few  months  of  nursing  may  cause  vomit- 
ing, but  this  is  very  rare,  and  would  necessitate  immedi- 
ate weaning. 

A — 1.  Overfeeding,  or  2.  Too  Rapid  Feeding. — 
When  vomiting  is  due  to  either  of  these  causes,  it  will 
occur  immediately  after  a  meal. 

Treatment  in  Bottle-Fed  Infants. — If  the  child  fin- 
ishes his  bottle  in  less  than  fifteen  or  twenty  minutes  (the 
correct  length  of  time),  examine  the  nipple,  and  replace 
it,  if  necessary,  by  one  with  a  smaller  hole.  If  the  vom- 
iting continues,  the  amount  of  the  feeding  is  probably 
too  large,  and  should  be  reduced  by  about  two  ounces  per 
feeding.  The  intervals  between  feedings  can  also  be 
lengthened  to  over  three  hours  with  advantage. 

3.  Too  Frequent  Feeding. — In  this  case  it  will  be 
sufficient  to  lengthen  the  intervals  between  meals  to 
over  three  hours.  A  child  should  never  be  coaxed  to 
feed,  nor  fed  at  irregular  intervals. 

4.  Handling  and  Playing  w^ith  a  Baby. — This  very 
frequently  produces  vomiting  when  indulged  in  soon  after 
feeding,  and  should  on  no  account  be  permitted.  (See 
chapter  on  Artificial  Feeding,  General  Directions  for 
Feeding.) 

5.  Tight  Abdominal  Binder. — It  is  always  well  to 
examine  the  clothing  of  a  vomiting  infant  to  see  if  the 
binder  or  any  other  article  of  clothing  is  fastened  too 
tightly  around  the  stomach  or  abdomen. 

B. — 1.  Excess  of  Fat. — This  condition  will  be  indi- 
cated by  repeated  vomiting  an  hour  or  more  after  feeding, 
and  often  by  the  character  of  the  stools. 

Treatment  in  Bottle-Fed  Infants. — In  bottle-fed  in- 
fants the  treatment  for  this  condition  is  explained  in  the 
chapter  on  Indigestion. 


88  HOW  TO  TAKE  CARE  OF  THE  BABY 

2.  Excess  of  Sugar  in  Bottle-Fed  Infants. — Vomiting 
may  result  from  the  use  of  condensed  milk,  malted  foods, 
or  too  much  cane  sugar.  It  is  frequently  accompanied 
by  flatulence,  sore  buttocks,  and  other  symptoms.  The 
treatment  consists  in  the  use  of  milk  sugar  only,  and  this 
in  smaller  quantities. 

C. — 1.  Acute  Indigestion. — This  is  frequently 
brought  on  by  cold  hands  and  feet,  and  insufficient  cloth- 
ing. Vomiting  will  usually  be  accompanied  by  colic,  and 
followed  by  diarrhea. 

Treatment. — The  child  must  be  kept  warm.  For 
treatment  in  the  case  of  a  nursing  infant  see  the  chapter 
on  Diarrhea.  The  treatment  of  a  bottle-fed  baby  is 
given  in  the  chapter  on  Indigestion  under  the  headings  of 
Treatment  and  Feeding  during  illness. 

2.  Chronic  Constipation. — The  frequent  vomiting 
of  a  small  amount  after  nearly  every  feeding  is  some- 
times due  to  constipation.  This  condition  may  be  rem- 
edied by  the  regular  administration  of  a  mild  cathartic, 
for  a  time. 

3.  Habit. — Habit  is  often  responsible  for  chronic 
vomiting,  or  "spitting  up,"  and  some  children  develop  the 
faculty  of  throwing  up  any  food  they  may  dislike.  It 
takes  time  and  patience  to  remedy  this  condition,  the 
treatment  consisting  in  reducing  the  usual  amount  of  each 
feeding,  or  by  nursing  for  a  shorter  time,  for  a  few  days. 
If  the  child  shows  signs  of  thirst,  give  water  between 
meals. 

D — Vomiting  from  Errors  in  Diet. — Faulty  diet  is 
frequently  responsible  for  vomiting  in  artificiall}'  fed 
children,  and  chief  among  the  errors  is  the  giving  of : 

1.  Unsuitable  or  indigestible  food,  which  irritates  or 
overstimulates  the  stomach. 

2.  Stale,  contaminated  or  insufficiently  cooked  food, 
especially  cereals  and  vegetables. 


A    MOTHER'S    GUIDE  89 

3.  Food  to  which  the  child  is  not  accustomed,  and 
which  has  been  given  in  too  large  an  amount. 

4.  Too  frequent  changes  in  the  food. 

General  Rule. — Whenever  a  child  vomits  repeatedly 
and  the  mother  is  in  doubt  as  to  the  cause,  pending  the 
arrival  of  a  physician,  the  treatment  should  be  along  the 
following  lines: 

1.  Give  barley  water  for  the  first  three  or  four  feed- 
ings. 

2.  Nurse  or  feed  less,  and  give  water  between  feedings. 

3.  Lengthen  the  intervals  between  feedings, 

4.  In  bottle-fed  children,  use  boiled  skimmed  milk, 
or  in  more  severe  cases,  partially  peptonized  skimmed 
milk,  in  place  of  whole  or  top  milk. 

5.  Give  less  sugar  of  any  kind. 

6.  Give  laxatives,  except  where  there  is  blood  in  the 
stools. 

7.  If  the  symptoms  do  not  abate,  give  a  colon  irri- 
gation, preferably  with  a  solution  of  bicarbonate  of  soda 
in  the  proportion  of  one  teaspoonful  to  one  pint  of  warm 
water. 

E — Conditions  Requiring  a  Physician's  Care. — Vom- 
iting often  occurs  in  certain  diseases  and  conditions  which 
require  the  immediate  attention  of  a  physician.  Among 
these  are  the  onset  of  fevers,  contagious  or  infectious 
diseases,  and  abnormal  conditions  of  the  blood,  stomach 
and  intestines,  besides  many  others. 

Of  the  latter,  two  are  briefly  described  below,  because 
the  first  (Acidosis)  may  become  very  alarming,  and  even 
cause  death,  and  because  in  the  second  condition  (Pyloric 
Stenosis)  a  mother  often  makes  the  serious  mistake  of 
weaning  her  infant  without  consulting  a  physician,  under 
the  impression  that  her  milk  is  to  blame. 

Acidosis. — This  condition  appears  mostly  in  chil» 
dren  between  two  and  four  years  of  age,  and  rarely  undeh 


90  HOW  TO  TAKE  CARE  OF  THE  BABY 

the  age  of  one  year.  It  is  caused  by  the  accumulation 
of  poisonous  products  in  the  blood  from  the  intestines. 

Symptoms. — Previous  to  the  onset  of  the  attack, 
the  child  may  be  "out  of  sorts,"  and  complain  of  head- 
ache and  slight  pain  in  the  stomach.  A  few  hours  later 
he  begins  to  vomit  all  food,  water,  and  even  cracked  ice. 
The  breath  often  has  a  peculiar  sweet  apple  odor,  and  the 
child  is  drowsy  and  tired.  The  glands  in  the  neck  may 
swell.  A  positive  diagnosis  of  Acidosis  can  never  be 
made,  however,  without  an  examination  of  the  urine. 

Treatment. — The  treatment  consists  in  the  free  ad- 
ministration of  bicarbonate  of  soda.  As  much  as  will 
go  on  a  ten-cent  piece  should  be  dissolved  in  a  little  water 
and  given  every  hour.  H  the  vomiting  does  not  cease 
in  a  few  hours,  a  colon  irrigation  of  a  solution  of  bi- 
carbonate of  soda  in  the  proportion  of  one  teaspoonful 
to  one  pint  of  warm  water,  should  be  given.  A  physician 
should  be  called  at  once. 

After  recovery,  not  more  than  one  pint  of  milk  should 
be  allowed  in  the  day. 

Pyloric  Stenosis. — This  is  a  condition  not  at  all  un- 
common in  the  first  few  weeks  of  life.  It  consists  of  a 
spasm  or  narrowing  of  the  outlet  of  the  stomach,  so  that 
the  milk  is  not  passed  on,  but  accumulates,  and  is  even- 
tually vomited.  As  very  little  food  passes  into  the 
intestines,  there  is  also  marked  constipation.  Prompt 
medical  attention  is  very  necessary  to  relieve  this  con- 
dition. 

DIARRHEA 

Nursing  Infants. — The  cause  of  diarrhea  in  a  nurs- 
ing baby  is  usually  to  be  found  in  the  mother's  milk  and 
the  treatment  for  this  is  explained  in  the  chapter  on 
Nursing.  Other  causes  may  be  catching  a  cold,  or  the 
result  of  lowered  vitality  from  too  much  clothing,  or 
from  heat,  especially  in  the  summer  months. 


A   MOTHER'S   GUIDE  91 

Simple  Diarrhea. — Nurse  less,  give  plenty  of  boiled 
water  between  the  feedings,  and  lengthen  the  intervals. 
This  treatment  will  usually  be  sufficient. 

Severe  Diarrhea. — In  severe  diarrhea,  with  or  with- 
out vomiting,  stop  nursing  for  twenty-four  hours. 
Give  one-half  to  two  ounces  of  cold  barley  water,  rice 
water,  or  albumen  water,  every  hour  or  two.  In  case  of 
great  weakness  give  brandy  in  small  amounts  as  explained 
later. 

After  twenty-four  hours  nurse  for  not  more  than  five 
minutes  every  four  hours,  and  give  plenty  of  boiled  water 
between  nursings.  Gradually  return  to  regular  nurs- 
ing after  three  or  four  days. 

Bottle-Fed  Infants. — The  most  frequent  causes  in 
artificially-fed  infants  are  overfeeding,  too  much  fat  or 
too  much  sugar.  These  have  all  been  considered  in  the 
chapters  on  Stools  and  Indigestion,  and  the  treatment 
explained. 

Diarrhea  is  often  brought  on  by  bad  or  impure  milk, 
or  by  lack  of  cleanliness  in  its  preparation,  by  too  fre- 
quent feeding,  or  by  sudden  changes  in  the  food  to 
which  the  child  is  not  accustomed.  The  cutting  of  teeth 
very  rarely  causes  diarrhea,  although  it  is  popularly 
supposed  to  do  so. 

It  may  also  be  the  result  of  giving  indigestible  or  in- 
sufficiently cooked  food ;  or,  in  the  case  of  older  children, 
of  fruits  and  vegetables  that  are  stale  or  unsuited  to  the 
child's  age.  Certain  infections  or  intestinal  diseases  often 
begin  with  diarrhea. 

No  disease  causes  more  trouble  in  infancy  than  diar- 
rhea, and  it  is  a  symptom  that  should  never  be  neg- 
lected. 

Simple  Diarrhea. — In  ordinary  mild  cases  the  onset 
is  slow.  The  child  may  be  restless,  sleepless  and  fretful ; 
he  usually  sufifers  from  colic  and  flatulence  and  may 
vomit.  This  depends  on  the  severity  of  the  attack.  From 


92  HOW  TO  TAKE  CARE  OF  THE  BABY 

twelve  to  twenty-four  hours  later  the  child's  bowels  be- 
gin to  move  more  often  than  usual.  The  stools  at  first 
are  normal,  but  as  they  become  more  frequent,  they  are 
smaller  in  amount,  and  thinner  in  consistency.  The  color 
turns  to  green,  and  they  may  later  contain  mucus.  Ten 
or  more  stools  a  day  are  not  unusual. 

Treatment. — Every  child  suffering  from  diarrhea 
should  stay  in  bed.  Begin  treatment  by  emptying  the 
bowels  thoroughly  with  castor  oil.  H  the  case  is  a  mild 
one,  dilute  the  food  one-fourth  to  one-half  with  water, 
gradually  resuming  the  usual  feeding  in  two  or  three 
days.  H  the  symptoms  do  not  abate,  stop  all  milk  and 
replace  it  with  barley  water  or  rice  water  for  twenty-four 
hours,  with  plenty  of  water  between  feedings.  When 
the  symptoms  have  improved,  return  to  a  mixture  of 
boiled  skimmed  milk  and  greatly  diluted,  gradually  in- 
creasing the  amount  of  milk.  If  the  diarrhea  is  not  bet- 
ter, give  protein  milk. 

Severe  or  Summer  Diarrhea. — This  is  a  very  se- 
vere form  of  diarrhea,  and  is  known  as  summer  diar- 
rhea because  it  is  most  prevalent  during  the  months  of 
June,  July  and  August ;  July  being  the  month  when  more 
cases  occur  than  at  any  other  time.  It  is  undoubtedly 
contagious  or  infectious,  and  is  more  often  due  to  im- 
pure or  contaminated  milk  and  want  of  cleanliness  than 
to  any  other  cause.  This  is  shown  by  the  fact  that  babies 
at  the  breast  rarely  get  it,  unless  their  surroundings  are 
unhygienic.  Other  frequent  causes  are  overfeeding,  too 
rich  milk,  errors  in  food,  warm  weather,  and  a  weakened 
condition  of  the  child. 

Symptoms. — With  this  acute  form  of  diarrhea,  a 
child  has  fever,  about  102°-105°  F.  He  is  restless  and 
sleepless,  or  listless  and  apathetic.  From  twelve  to  twen- 
ty-four hours  after  the  onset  of  fever,  the  stools  become 
loose  and  green  and  contain  curds  and  mucus.  There  may 
be  anywhere  from  ten  to  twenty  movements  a  day,  often 


A   MOTHER'S   GUIDE  93 

accompanied  by  vomiting.  The  skin  is  at  first  flushed  and 
dry,  but  later  becomes  pale.  The  face  looks  pinched,  and 
the  eyes  are  sunken.  The  child  suffers  from  thirst,  and 
his  tongue  is  coated  and  dry ;  his  hands  and  feet  feel 
cold  and  may  be  blue.  There  is  rapid  loss  of  weight  and 
the  child's  whole  appearance  denotes  serious  illness. 

Treatment. — A  cathartic  must  be  given  at  once, 
preferably  calomel  followed  by  castor  oil  five  hours  later 
(for  doses,  see  common  remedies,  page  158).  Give  a 
colon  irrigation  with  a  saline  solution  (see  Injections, 
page  160).  If  the  child  has  cold  hands  and  feet,  give  a 
hot  mustard  bath  (see  page  12),  wrap  him  in  blankets 
that  have  been  warmed  by  the  fire  and  place  a  hot  water 
bottle  at  his  feet  and  one  on  either  side  of  his  body. 

Give  the  child  nothing  by  mouth  except  hot  water  which 
has  been  boiled  and  cooled  to  about  102°F.,  or  as  hot 
as  can  be  drunk  with  comfort,  for  the  first  twelve  to 
twenty-four  hours.  This  is  absolutely  necessary  to  in- 
sure recovery.  No  greater  mistake  can  be  made  than 
to  give  a  child  food  when  it  is  in  this  condition.  Milk 
in  any  form  must  be  withheld,  and  rice  water  or  albumen 
water  (see  page  154)  given  thereafter  until  the  symp- 
toms improve,  but  in  very  small  quantities  at  first.  Begin 
by  giving  two  or  three  teaspoon  fuls  every  hour  for  two 
or  three  hours,  then  an  ounce  every  hour  for  two  or  three 
hours,  then  gradually  increasing  the  amount  and  length- 
ening the  intervals.  If  the  child  is  thirsty  give  plenty  of 
cool  boiled  water. 

Children  over  nine  or  ten  months  old  can  be  given 
broths,  or  bouillon  made  from  chicken,  veal  or  beef. 
If  the  child  is  very  weak  during  these  days,  give  small 
quantities  of  brandy  or  whiskey  as  follows:  Five  drops 
for  a  child  under  six  months  old,  ten  drops  from  six  to 
twelve  months  old,  fifteen  drops  over  one  year,  diluted 
in  at  least  two  teaspoon  fuls  of  water,  and  administered 
every  three  or  four  hours.    This  should  not  be  kept  up 


94  HOW  TO  TAKE  CARE  OF  THE  BABY 

for  more  than  two  or  three  days,  and  on  no  account 
should  larger  doses  be  given. 

If  the  diarrhea  does  not  improve  on  the  second  day, 
give  another  colon  irrigation,  and  repeat  it  the  next  day 
if  the  stools  are  frequent  and  very  foul  smelling,  and  the 
abdomen  is  distended.  Put  a  woolen  band  snugly  around 
the  child's  abdomen.  If  he  is  feverish  or  hot,  give  luke- 
warm sponge  baths  every  three  or  four  hours,  and  do  not 
put  too  much  covering  on  the  bed.  As  soon  as  the  diar- 
rhea has  improved,  give  protein  milk.     (See  page  63.) 

Later  begin  with  small  amounts  of  skimmed  or  whole 
milk  previously  boiled  or  pasteurized,  and  during  the  rest 
of  the  summer  never  give  milk  that  has  not  been  so 
treated. 

Try  to  resume  the  original  feeding  gradually,  bearing 
in  mind  that  the  child  will  often  not  be  able  to  stand 
so  strong  a  mixture  as  before  until  the  advent  of  cooler 
weather.  Never  attempt  to  return  to  the  original  for- 
mula under  two  or  three  weeks  after  the  onset  of  the 
attack. 

No  paregoric  or  patent  medicines  of  any  kind  should 
ever  be  given  during  an  attack  of  diarrhea  except  by  the 
order  of  a  physician. 

Complications. — A  mother  should  not  attempt  to 
treat  a  severe  case  of  diarrhea  without  the  advice  of  a 
physician.  Severe  diarrhea  is  sometimes  complicated  by 
thrush,  bronchitis,  inflammation  of  the  ear,  and  con- 
vulsions. 

Rules  for  Feeding  in  Hot  Weather. — IMany  severe 
cases  of  diarrhea  could  be  prevented  if  proper  treatment 
were  begun  as  soon  as  the  first  symptoms  showed  them- 
selves. No  slight  looseness  of  a  child's  bowels  should 
ever  be  allowed  to  continue  in  summer-time.  Diarrhea 
may  often  be  prevented  by  taking  the  following  precau- 
tions during  the  warm  season : 

1.    Feed  at  longer  intervals. 


A    MOTHER'S    GUIDE  95 

2.  Dilute  the  food  one-quarter  to  one-half,  especially 
at  midday. 

3.  Make  up  milk  formulas  with  skimmed  milk.  (See 
page  59.) 

4.  If  not  sure  that  the  milk  is  very  pure,  pasteurize 
or  boil  it.    If  it  is  impure,  do  not  use  it  at  all. 

5.  Give  a  sponge  bath  two  or  three  times  a  day  if 
the  child  suffers  from  the  heat. 

6.  See  that  the  child's  clothing  is  light  and  loose. 

7.  Give  plenty  of  boiled  water  to  drink  between 
feedings. 

8.  Keep  the  child  out-of-doors  in  the  shade  as  much 
as  possible. 

9.  Be  sure  that  food,  utensils  and  hands  are  always 
scrupulously  clean  when  preparing  the  food. 

CONSTIPATION 

Chronic  Constipation. — Constipation  is  not  very 
common  among  nursing  infants,  but  is  one  of  the  most 
troublesome  conditions  among  those  artificially  fed,  and 
in  older  children.  If  neglected,  and  allowed  to  become 
chronic,  it  is  often  the  cause  of  a  baby's  failing  to  gain 
in  weight,  and  may  lead  to  more  serious  trouble. 

Warning  Against  Too  Frequent  Cathartics. — Be- 
fore giving  any  treatment  the  cause  must  be  first  deter- 
mined, and  the  constant  use  of  enemas  and  cathartics, 
especially  castor  oil,  should  not  be  resorted  to,  as  the 
relief  obtained  from  them  is  only  temporary,  and  their 
repeated  use  is  very  frequently  one  of  the  chief  causes 
of  the  disorder. 

Gluten  Suppository. — In  very  young  infants  consti- 
pation is  often  the  result  of  inability  to  make  the  neces- 
sary effort  to  expel,  and  the  insertion  of  a  gluten  supposi- 
tory will  be  immediately  followed  by  a  normal  stool.  It 
is  only  when  this  condition  is  joined  to  symptoms  of 


96  HOW  TO  TAKE  CARE  OF  THE  BABY 

indigestion,  such  as  foul  breath,  restlessness,  etc.,  that  a 
cathartic  should  be  given. 

Causes. — The  two  chief  causes  of  constipation  are 
an  improper  diet  and  lack  of  muscular  development  in 
the  intestines.  The  latter  condition  is  often  aggravated 
by  neglect,  and  the  failure  of  the  mother  or  nurse  to 
begin  early  training  of  the  bowels  for  their  daily  function. 

Breast-Fed  Baby. — If  a  breast-fed  baby  is  habitually 
costive,  it  is  the  mother's  diet  and  regime  which  should 
receive  attention,  as  it  is  usually  the  result  of  low  fat 
in  her  milk.  (See  chapter  on  Nursing,  page  23,  for  diet 
and  regime  to  be  followed  by  the  mother.)  Sometimes 
the  addition  of  one  bottle  a  day  of  the  regular  formula 
will  remedy  the  condition. 

If  it  is  quite  certain  that  the  mother's  milk  is  deficient 
in  fat,  and  this  can  only  be  definitely  known  by  having 
the  milk  analyzed,  it  is  sometimes  advisable  to  give  the 
baby  a  little  fresh  cream  and  warm  water  before  nurs- 
ing ;  the  cream  should  not  be  bought  as  such,  but  should 
rise  on  the  best  certified  milk,  and  one  or  two  teaspoon- 
fuls  mixed  with  two  or  three  of  water  should  be  given. 
Caution  must  be  exercised  with  this,  for  if  a  little  too 
much  fat  is  given,  indigestion  will  be  added  to  the  consti- 
pation, and  matters  will  be  worse  than  before. 

Another  method  of  giving  the  child  additional  fat  if 
the  cream  does  not  agree  is  to  administer  a  little  pure 
olive  oil  after  nursing,  beginning  with  half  a  teaspoonful 
three  times  a  day,  and,  if  necessary,  increasing  to  one 
teaspoonful.  One-half  ounce  a  day  will  usually  be  found 
sufficient. 

Causes  in  Artificially-Fed  Infants. — In  young  infants 
who  are  bottle-fed  sluggishness  of  the  bowels  may  be 
caused  by : 

1.  Overheating  the  bottle,  thereby  almost  converting 
it  into  boiled  milk. 

2.  Peptonized  or  boiled  milk. 


A   MOTHER'S   GUIDE  97 

3.  Insufficient  water,  especially  in  warm  weather  or 
if  the  child  has  been  in  overheated  rooms,  or  too  warmly 
clad. 

4.  Continued  use  of  food  containing  too  little  solid 
matter,  as  condensed  milk,  broth  and  barley  water. 

5.  Food  containing  too  small  an  amount  of  fat  or 
cream. 

With  Older  Children. — With  older  children,  it  may 
also  be  caused  by  insufficient  exercise,  and  by  giving  too 
much  starchy  food,  and  too  little  vegetables  and  fruit. 

Rarer  Causes. — Other  causes  which  are  much  less 
common  are : 

1.  General  weakness  and  debility,  occurring  in  rickets, 
malnutrition,  etc. 

2.  The  result  of  severe  and  prolonged  diarrhea,  which 
has  weakened  the  bowels. 

3.  Malformation  or  injury  in  the  lower  part  of  the 
bowels.    (This  condition  is  very  rare.) 

Treatment. — The  treatment  in  the  great  majority 
of  cases  is  by  attention  to  the  food.  It  will  sometimes  be 
sufficient  to  increase  the  amount  of  the  food,  or  to  make 
it  stronger,  but  both  should  not  be  done  at  the  same  time. 

If  this  does  not  answer,  the  cause  may  be  deficiency 
in  fat,  and  this  can  be  remedied  by  using  top-milk  (see 
page  56),  or  by  the  addition  of  one-half  to  two  ounces 
of  cream  to  the  day's  feeding.  Another  method  is  to 
give  olive  oil  in  the  same  way  as  mentioned  above. 

Other  Methods  of  Relieving  Constipation. — One  of 
the  malt  sugars  (page  52)  added  to  the  food  will  often 
produce  normal  stools,  but  the  milk  sugar  or  cane  sugar 
must  be  omitted.  None  of  these  preparations  can  be 
given  when  there  is  vomiting. 

Laxative  for  Young  Infants. — A  very  satisfactory 
laxative  for  a  young  baby  is  Milk  of  Magnesia,  one-half 
to  one  teaspoon ful  in  the  last  bottle  of  the  day,  at  10  p.  m. 

Caution  Against  Hasty  Changes  in  Treatment. — 


98  HOW  TO  TAKE  CARE  OF  THE  BABY 

Too  hasty  changes  should  not  be  made  in  the  mode  of 
treatment,  and  any  remedy  selected  should  be  given  a 
fair  trial  before  rejecting  it  in  favor  of  another.  The 
simplest  measure  should  always  be  tried  first,  and,  in 
any  case,  plenty  of  water  should  be  given  between  feed- 
ings, as  this  has  a  very  beneficial  effect  on  the  bowels. 

Oatmeal  Water. — When  a  child  reaches  the  age  of 
three  or  four  months  we  have  a  greater  choice  of  meth- 
ods of  treatment  for  constipation.  One  to  be  recom- 
mended is  the  use  of  oatmeal  water  instead  of  plain 
water  for  diluting  the  milk.  The  Health  Food  Company's 
oatm.eal  flour  is  the  one  generally  used,  and  directions 
for  making  oatmeal  water  are  given  on  page  155.  Beef 
juice  and  broths  will  also  be  introduced  into  the  diet  a 
little  later,  and  these  changes  in  the  food  will  help  in 
overcoming  habitual  constipation. 

Orange  or  Prune  Juice. — After  seven  or  eight 
months  of  age,  orange  or  prune  juice  can  be  given,  be- 
ginning with  two  teaspoonfuls  one  hour  before  the  sec- 
ond bottle  in  the  morning,  and  gradually  increasing  it  to 
one  or  two  ounces  at  twelve  months  of  age. 

Oatmeal  Jelly. — After  six  months  of  age,  well 
cooked  oatmeal  can  be  strained  and  the  gruel  or  jelly 
mixed  with  the  feedings,  beginning  with  one  ounce  to 
each  twenty  ounces  of  mixture. 

At  Eighteen  Months. — Baked  apples  and  the  pulp 
of  stewed  prunes  will  be  of  help  in  overcoming  constipa- 
tion in  a  child  over  eighteen  months  old.  After  two 
years  a  few  other  fruits  may  be  given  in  moderate  quan- 
tities, such  as  fresh,  ripe,  peeled  pears  and  peaches,  but 
not  apples,  bananas,  or  any  fruit  containing  seeds.  Fruit 
must  never  be  given  in  excess  in  an  effort  to  overcome 
constipation. 

Do  not  give  older  children  large  amounts  of  oatmeal 
or  whole  wheat  bread  in  attempting  to  correct  habitual 


A   MOTHER'S   GUIDE  99 

constipation ;  they  only  irritate  the  intestines  and  in  many 
cases  are  passed  in  a  totally  undigested  condition. 

Castor  Oil. — Do  not  give  castor  oil  as  a  remedy  for 
chronic  constipation  at  any  age ;  in  small  doses  it  is  con- 
stipating and  in  larger  ones  it  will  clear  out  the  bowels, 
but  will  have  a  costive  after-effect,  making  it  necessary 
to  repeat  the  dose  indefinitely. 

Oil  Enema. — An  enema  of  one  or  two  ounces  of 
sweet  oil  injected  slowly  into  the  rectum  at  bed  time 
may  sometimes  overcome  chronic  constipation.  After 
the  injection  the  buttocks  should  be  held  tightly  to- 
gether for  a  few  minutes.  Shortly  after  waking  up  the 
next  morning  the  child  will  have  a  good  movement  of 
the  bowels. 

Liquid  Petrolatum. — In  obstinate  cases  of  consti- 
pation, where  every  remedy  has  failed  and  attention  to 
the  diet  has  been  without  success,  we  can  employ  liquid 
petrolatum  (Russian  oil),  which  is  a  pure  paraffin  oil. 
As  it  is  a  mineral  product  it  can  not  be  absorbed  by  the 
system,  but  acts  solely  as  a  lubricant.  It  has  been  used 
for  several  years  in  England,  but  only  recently  in  this 
country. 

This  oil  can  be  taken  plain  or  flavored  with  pepper- 
mint, wintergreen,  orange  juice,  lemon,  etc.  It  may  be 
given  before  or  after  meals,  two  or  three  times  a  day. 
The  amount  varies  with  every  child,  from  one-half  to 
two  ounces  a  day,  or  more.  Begin  with  small  quantities, 
such  as  a  teaspoonful  three  times  a  day,  and  increase 
the  amount  by  one  teaspoonful  a  day  until  good  results 
are  obtained ;  thereafter  the  quantity  should  be  gradually 
reduced. 

Calomel. — A  dose  of  calomel  is  indicated  when  there 
is  flatulence  and  the  stools  are  dry,  hard  and  white,  but 
it  must  not  be  used  continuously. 

Importance  of  Regular  Habits. — Above  all,  remem- 


100  HOW  TO  TAKE  CARE  OF  THE  BABY 

ber  the  importance  of  training  a  child's  bowels  to  a  free 
evacuation  every  day  at  the  same  hour.  This  habit  will 
often  be  the  means  of  preventing  many  of  the  ailments 
of  childhood. 

MALNUTRITION  AND  MARASMUS 

Malnutrition  and  marasmus  in  infants  are  different 
degrees  of  the  same  condition.  The  term  malnutrition 
may  be  used  to  denote  a  case  of  digestive  disturbance 
with  rapid  loss  of  weight  for  a  short  time ;  stationary 
weight,  or  steady,  slight  loss  for  a  longer  time;  this 
becomes  marasmus  when  the  condition  is  aggravated, 
and  the  child  becomes  greatly  emaciated  and  still  con- 
tinues to  lose  weight  steadily. 

Causes. — These  conditions  may  be  the  result  of  tu- 
berculosis, syphilis,  and  other  diseases,  but  by  far  the 
most  common  causes  are  improper  feeding,  and  persist- 
ing in  giving  food  that  is  not  being  digested  by  the  baby. 
Lack  of  fresh  air  and  unhealthy  surroundings  are  also 
contributory  causes. 

Marasmus  is  more  often  seen  in  institutions,  but  mal- 
nutrition is  fairly  common  everywhere.  It  is  frequently 
due  to  digestive  disturbances  brought  on  by  insufficient 
dilution  of  cow's  milk  in  early  infancy,  for  although 
there  are  children  who  can  stand  strong  mixtures  of 
cow's  milk  from  birth,  and  thrive  on  it,  they  are  excep- 
tions to  the  rule.  Excess  of  cream  or  fat  is  also  a  fre- 
quent cause,  as  is  overfeeding,  and  sometimes  excess  of 
starch. 

These  errors  in  feeding  are  often  the  result  of  mis- 
taken zeal  in  trying  to  make  a  baby  gain  weight  rapidly. 
This  he  often  does  for  a  short  time,  without  showing 
any  signs  of  indigestion,  but  suddenly  the  weight  remains 
stationary,  and  then  the  child  gradually  sinks  into  a  con- 
dition of  malnutrition  and  perhaps  marasmus. 


A   MOTHER'S   GUIDE  101 

Irregularity  in  the  hours  for  feeding,  unsuitable  food, 
chronic  constipation  or  any  other  causes  resulting  in  di- 
gestive disorders  and  imperfect  nutrition  may  also  lead 
to  marasmus. 

S5miptoms  and  Treatment. — The  digestive  symp- 
toms vary  in  different  cases,  vomiting  and  diarrhea  be- 
ing present  in  some,  and  not  in  others,  but  a  constant 
symptom  is  steady  loss  of  weight.  Infants  in  this  condi- 
tion usually  sleep  badly  and  are  anemic. 

This  condition  is  one  that  calls  for  careful  study  and 
constant  supervision  by  a  physician,  and  no  hard  and  fast 
rule  can  be  laid  down  for  feeding  in  these  cases. 

Feeding. — If  the  baby  is  under  six  months  of  age, 
it  is  advisable  to  try  a  wet-nurse.  Above  that  age  wet- 
nursing  will  rarely  be  successful,  and  the  question  of 
feeding  is  most  difficult.  In  severe  cases  very  weak  mix- 
tures of  peptonized  milk  often  have  to  be  given  for  some 
time  before  any  improvement  is  noticed.  In  all  cases 
the  stools  and  general  symptoms  must  be  carefully 
watched. 

If  the  weight,  which  has  been  dropping  steadily,  be- 
comes stationary,  or  rises  ever  so  little,  do  not  on  any 
account  increase  the  food  or  change  it  in  any  way  for  a 
few  days. 

In  some  cases  too  much  dilution  of  food  will  not 
answer,  and  a  small  quantity  of  stronger  food  will  give 
better  results.  At  other  times  when  fats  are  badly  tol- 
erated, a  little  olive  oil  is  sometimes  useful. 

If  the  bowels  are  not  loose  and  there  is  no  vomiting 
the  addition  of  a  small  amount  of  malt  soup  is  occa- 
sionally beneficial.  The  physician,  however,  will  be  the 
best  judge  of  this,  and  his  orders  must  be  carefully 
carried  out.  Many  cases  of  marasmus  have  been  made 
much  worse  by  following  the  advice  of  well-meaning 
friends. 


.102  HOW  TO  TAKE  CARE  OF  THE  BABY 

Additional  Care. — ^\^ery  intelligent  care  is  required 
from  the  mother  or  nurse  co-operating  with  the  physi- 
cian, as  an  infant  in  this  condition  has  very  little  power 
of  resistance  and  his  chances  of  life  are  small  if  any 
complications  arise.  Everything  possible  should  be  done 
to  preserve  and  increase  the  child's  vitality,  as  much  will 
depend  on  it. 

Airing  and  Warmth. — The  infant  needs  an  abun- 
dance of  fresh  air,  but  he  also  requires  a  great  deal  of 
warmth,  particularly  as  regards  his  hands  and  feet.  If 
necessary,  a  hot  water  bottle  should  be  kept  near  the  feet 
all  the  time.  In  summer  he  ought  to  be  out-of-doors 
all  day,  in  spring  or  autumn  for  the  greater  part  of  the 
day,  and  in  the  winter  when  the  weather  is  unsuitable  or 
too  cold  he  should  have  an  "indoor  airing"  three  or  four 
times  a  day  (see  Airing).  Strict  attention  should  be  paid 
to  the  ventilation  of  the  nursery,  but  the  baby  must  never 
be  allowed  to  become  chilled. 

Salt  Bath  and  Oil  Frictions. — A  salt-bath  should  be 
given  daily  (see  Bathing)  and  followed  by  a  rubbing 
from  head  to  foot  with  goose  grease  or  cocoa  butter. 
Always  rub  toward  the  heart,  that  is,  from  the  ankle 
toward  the  hip,  etc. 

Frequent  Changes  of  Position. — A  baby  suffering 
from  marasmus  must  not  be  allowed  to  remain  too  long 
in  one  position;  he  must  be  turned  occasionally  when 
sleeping,  and  when  awake  he  should  be  picked  up  and 
carried  about  several  times  a  day.  He  must  not  be  al- 
lowed to  cry  too  much,  and  especial  care  should  be  taken 
to  keep  him  always  clean  and  comfortable. 

Chances  of  Recovery. — The  prospect  for  a  baby's 
recovery  is  usually  more  hopeful  the  older  he  is,  for  he 
is  apt  to  have  more  vitality  than  in  the  earlier  months. 

Although  the  improvement  in  cases  of  malnutrition  or 
marasmus  is  invariably  a  very  slow  process,  with  proper 


A   MOTHER'S    GUIDE  103 

care  the  ultimate  recovery  is  absolute,  and  after  the  age 
of  three  or  four  years  they  will  be  as  strong  as  other 
children. 

Malnutrition  in  Older  Children. — Malnutrition  in 
children  over  tv^^o  years  old  is  often  the  result  of  a  pre- 
vious severe  illness.  They  are  anemic,  nervous,  and 
show  little  resistance  to  diseases.  Disturbances  of  di- 
gestion arise  from  slight  causes,  and  they  need  constant 
care  in  order  to  keep  them  in  even  moderate  health. 
Regularity  in  feeding,  plain  diet,  no  overfeeding,  plenty 
of  fresh  air,  no  excitement,  and  plenty  of  sleep  will 
usually  result  in  a  successful  cure,  but  the  improvement 
will  be  slow,  and  constant  supervision  is  necessary. 

COLDS  AND   THEIR   CAUSES 

The  Most  Frequent  Causes. — Colds  and  their  com- 
plications are  most  frequently  brought  on  in  children  of 
all  ages  by  the  following  causes : 

1.  Insufficient  clothing,  easily  shown  by  cold  hands 
and  feet,  blue  lips,  etc.,  or  too  light  head  covering  when 
out-of-doors,  especially  in  young  infants. 

2.  Excessive  clothing,  inducing  perspiration,  with  the 
result  that  cold  air  often  blows  on  a  moist  skin  and  thus 
chills  it. 

3.  Overheated  and  badly  ventilated  rooms,  tending 
to  lower  the  child's  vitality. 

4.  Contact  with  other  children  or  adults  suffering 
from  colds. 

5.  The  use  of  another's  pocket  handkerchief. 

6.  Kicking  off  bed  covers  while  asleep.  To  remedy 
this  the  blankets  should  be  securely  pinned  or  tied  down, 
or  a  thicker  night  dress  put  on  the  child. 

A  Few  Rules  for  Preventing  Colds  in  Infants. — For 
the  prevention  of  colds  in  infants  in  arms  the  following 
advice  may  be  of  use : 


104  HOW  TO  TAKE  CARE  OF  THE  BABY 

1.  Do  not  subject  a  baby  to  sudden  changes  of  tem- 
perature, such  as  carrying  him  from  a  warm  room 
through  a  cold  hall  without  the  addition  of  extra  cloth- 
ing. 

2.  Do  not  hold  him  near  a  window  in  cold  weather. 

3.  Do  not  allow  the  baby  to  play  on  the  floor  in  cold 
weather;  there  is  always  a  draft  near  the  floor.  An 
"exercise  pen"  raised  two  or  three  feet  is  an  excellent 
device,  as  it  enables  the  child  to  roll  about  and  kick  with- 
out running  the  risk  of  catching  cold. 

4.  Never  put  a  baby  in  a  draft  in  the  house  or  in  a 
windy  spot  out-of-doors. 

5.  Keep  him  out  of  the  dust,  particularly  if  living 
in  a  city. 

6.  Be  on  your  guard  against  a  sudden  drop  in  tem- 
perature in  the  baby's  room  at  night,  and  have  an  extra 
blanket  or  quilt  ready  to  put  over  him  when  necessary. 

Older  Children. — With  older  children  wet  feet  are 
a  most  common  cause  of  colds.  When  the  stockings  or 
shoes  are  damp  they  should  be  changed  immediately. 

When  children  have  taken  much  exercise  out-of-doors 
their  underclothing  and  stockings  will  be  moist  from  per- 
spiration and  the  skin  will  be  damp.  If  they  stop  romp- 
ing or  playing,  or  worse  still,  stand  about  in  a  breeze,  or 
go  indoors  and  allow  the  underclothing  to  dry  on  their 
bodies,  they  are  very  liable  to  catch  severe  colds.  All 
damp  underclothing  should  be  changed  at  once  and  the 
body  rubbed  down  with  rough  dry  towels. 

I  have  also  found  by  experience  that  the  wearing  of 
woolen  underwear  and  woolen  stockings  by  children  who 
take  much  exercise  is  most  conducive  to  frequent  colds. 
Children  over  eighteen  months  old  should  wear  cotton 
underclothing  only. 

Chronic  Colds. — Where  children  suffer  from  re- 
peated or  chronic  colds  and  coughs,  enlarged  tonsils  and 
adenoids  are  often  the  cause.    When  this  is  found  to  be 


A   MOTHER'S   GUIDE  105 

the  case,  they  should  be  removed  by  a  surgeon.  This 
simple  operation  is  always  followed  by  a  marked  im- 
provement in  the  child's  general  condition. 

When  children  are  over  a  year  old,  the  chest  and  back 
should  be  sponged  daily  with  cold  water,  followed  by 
rubbing,  thus  rendering  the  child  less  susceptible  to  re- 
peated colds. 

Treatment  for  Colds. — If  the  cold  is  in  the  head, 
with  discharge  from  the  nose,  spray  it  by  means  of  a 
nasal  atomizer  with  warm  boric  acid,  using  a  solution 
of  one  teaspoonful  to  a  pint  of  water,  or  with  a  Dobell's 
solution  diluted  with  an  equal  amount  of  warm  water. 
A  few  drops  of  albolene  dropped  in  the  nose  with  a  medi- 
cine dropper  will  also  relieve  it. 

Treatment  for  a  Cold  with  Slight  Cough. — When 
the  cold  is  accompanied  by  a  cough  it  is  advisable  to 
keep  the  child  in  an  even  and  warm  temperature,  and 
preferably  in  bed.  Rub  the  chest,  neck  and  back,  morn- 
ing and  evening,  with  a  mixture  of  half  capsicum  vaseline 
and  half  plain  vaseline,  or  with  equal  parts  of  camphor- 
ated oil  and  spirits  of  turpentine. 

Croup  Kettle. — A  croup  kettle  should  be  a  part  of 
the  furnishings  of  every  nursery,  and  should  be  used 
two  or  three  times  a  day  in  all  cases  of  colds  and  coughs. 
The  "Simplex"  croup  kettle  is  the  simplest  and  is  not  so 
easily  upset  as  most  of  the  others.  It  can  be  obtained 
through  J.  T.  Dougherty,  409  West  Fifty-ninth  Street, 
New  York  City.  To  a  pint  of  water  in  the  kettle  is 
added  a  teaspoonful  of  Compound  Tincture  of  Benzoin ; 
then  a  tent  is  arranged  by  placing  sheets  over  the  crib, 
leaving  only  space  enough  to  insert  the  spout  of  the  ket- 
tle. The  child  should  inhale  the  steam  from  this  for 
fifteen  or  twenty  minutes  at  a  time.  If  he  is  old  enough 
to  sit  up,  and  prefers  to  do  so,  the  tent  can  be  made  by 
raising  an  umbrella  over  his  head  and  covering  top  and 
sides  with  sheets,  closing  them  in  as  before. 


106  HOW  TO  TAKE  CARE  OF  THE  BABY 

Additional  Treatment. — In  addition  to  this  treat- 
ment a  simple  cathartic,  such  as  castor  oil  or  calomel, 
should  be  given,  as  it  will  help  to  dissipate  the  cold. 
When  a  child  has  a  high  temperature,  or  seems  to  be  in 
much  discomfort  from  a  cold,  no  time  should  be  lost  in 
sending  for  a  physician. 

A  cold  may  often  be  cut  short  by  prompt  treatment 
and  by  keeping  the  child  indoors  for  a  day  or  two,  or 
until  the  symptoms  have  entirely  disappeared.  To  take 
a  child  who  is  suffering  from  a  cold  out-of-doors  will 
surely  make  matters  worse  unless  the  weather  is  very 
warm. 

BRONCHITIS 

Cause  and  Symptoms. — Bronchitis  is  often  the  re- 
sult of  a  cold  that  has  been  neglected.  The  bronchial 
tubes  are  the  parts  affected,  and  if  allowed  to  remain 
untreated  the  condition  is  apt  to  get  worse.  It  is  accom- 
panied by  a  dry  cough  and  loss  of  appetite.  There  is  a 
wheezing  in  the  chest,  and  when  the  hand  is  placed 
against  it  a  "purring"  can  often  be  detected.  There  is 
slight  fever,  about  i00°-102°F. 

Treatment. — The  child  should  be  kept  in  bed,  in  a 
warm,  even  and  moist  temperature,  and  should  be  made 
to  inhale  the  steam  from  a  croup  bottle,  as  shown  in 
chapter  on  colds  (page  105).  The  food  must  be  simple 
and  easily  digestible  and  diluted  one-quarter  to  one-half 
with  water,  if  the  patient  is  an  infant.  If  the  child  is 
breast  fed,  one  ounce  of  water  should  be  given  before 
putting  him  to  the  breast. 

Local  Applications. — Local  applications  are  most 
beneficial,  and  if  used  early  enough  will  often  shorten 
the  attack.  The  mustard  plaster  is  the  one  most  com- 
monly employed  and  is  made  as  follows : 

Mustard  Plaster. — Mix  one  part  of  English  mustard 
with  five  parts  of  flour,  add  warm  water  enough  to  make 


A   MOTHER'S   GUIDE  107 

a  thin  paste  and  stir.  Take  a  piece  of  muslin  long 
enough  and  wide  enough  when  folded  to  go  around  the 
chest.  Spread  this  on  a  table  and  smear  the  mustard 
paste  in  the  center,  folding  all  four  sides  up  so  as  to 
close  it  tightly.  Before  applying,  rub  the  child's  chest 
and  back  lightly  with  sweet  oil  or  vaseline  to  prevent 
blistering.  Put  the  mustard  plaster  over  the  chest  and 
pin  a  piece  of  flannel  over  it  and  around  the  child 
like  a  bandage.  Leave  it  on  for  ten  or  fifteen  minutes, 
lifting  it  from  time  to  time  in  different  places  to  see  if 
the  skin  is  red.  When  the  chest  is  reddened,  remove  it, 
wipe  the  skin  dry  with  a  towel  and  cover  the  child  up 
carefully. 

Other  Applications. — In  place  of  a  mustard  plaster, 
other  simpler  applications  are  just  as  efficacious.  When 
obtainable,  they  have  the  advantage  of  being  more  easily 
and  quickly  applied  and  can  be  rubbed  on  the  neck  as 
well.  One  is  capsicum  vaseline,  which  comes  in  tubes. 
A  small  amount  should  be  squeezed  out  and  mixed  with 
an  equal  amount  of  plain  vaseline  and  then  lightly  rubbed 
over  the  chest,  back  and  neck.  The  child  should  be 
watched  to  see  that  he  does  not  get  this  on  his  hands 
and  then  rub  his  eyes,  as  it  might  cause  severe  inflam- 
mation. 

Another  useful  application  can  be  made  with  a  mix- 
ture of  equal  parts  of  camphorated  oil  and  spirits  of 
turpentine.    This  should  be  applied  in  the  same  way. 

When  the  bronchitis  is  of  a  mild  type  one  of  these 
local  applications  morning  and  evening  will  be  sufficient. 
In  severe  cases  it  might  be  necessary  to  repeat  them 
every  four  or  five  hours,  and  as  the  symptoms  improve 
they  can  be  discontinued. 

To  Relieve  the  Cough. — To  relieve  the  cough  it  is 
best  to  consult  a  physician.  In  his  absence  Brown  mix- 
ture can  be  administered.  For  doses,  see  page  159.  The 
use  of  the  croup  kettle  will  often  assist  in  breaking  up 


108  HOW  TO  TAKE  CARE  OF  THE  BABY 

an    obstinate    cough.      For    directions,    see    chapter    on 
"Colds." 

It  is  very  important  to  keep  a  child  indoors  in  an  even 
temperature  until  all  symptoms  have  disappeared.  A 
cough  is  only  prolonged  by  allowing  him  to  go  out-of- 
doors  too  soon. 

HICCOUGH 

Hiccough  is  usually  caused  by  irritation  of  the  stomach 
an.d  bowels,  either  from  gases  or  excessive  amount  of 
food.  It  is  sometimes  caused  by  taking  the  food  too 
quickly  or  too  hot. 

It  can  be  relieved  by  a  dose  of  rhubarb  and  soda  mix- 
ture (page  160).  A  colon  irrigation  will  sometimes  re- 
lieve it.  Plain  cooking  soda,  one-quarter  teaspoon  ful  dis- 
solved in  a  tablespoonful  of  water,  will  often  give  relief. 

SPASMODIC  CROUP 

This  is  a  spasm  of  the  vocal  chords,  following  a  ca- 
tarrh of  the  larynx,  and  usually  occurs  in  young  children. 

Symptoms. — Some  hoarseness  and  cough  are  noticed 
in  the  daytime.  The  child  goes  to  sleep  comfortably  and 
an  hour  or  more  afterward  wakes  up  suddenly  with  a 
loud  barking  metallic  cough,  anxious  face,  and  great 
difficulty  in  breathing,  and  appears  to  choke.  It  is  most 
alarming,  but  there  is  really  no  danger  if  the  proper 
treatment  is  given  at  once.  The  temperature  may  be 
slightly  raised. 

Treatment. — Give  the  child  at  once  a  teaspoonful 
of  wine  of  ipecac,  or  sirup  of  ipecac,  one  of  which 
should  always  he  kept  in  the  house,  and  repeat  this  dose 
every  ten  minutes  until  he  vomits.  One  or  two  doses 
are  usually  sufficient,  but  no  harm  can  be  done  by  re- 
peating it  until  he  gets  sick.    He  will  bring  up  his  food, 


A   MOTHER'S    GUIDE  109 

as  well  as  some  mucus,  and  will  then  feel  greatly  re- 
lieved. 

The  room  should  be  kept  warm,  and  the  child  should 
be  made  to  inhale  from  a  croup  kettle  (see  Colds).  If 
a  croup  kettle  is  not  available,  he  can  inhale  the  steam 
from  an  ordinary  kettle.  Relief  is  often  afforded  by 
warm  compresses  or  flaxseed  poultices  alternating  with 
compresses  wrung  out  of  ice-cold  water  and  applied  to 
the  throat.  To  make  the  air  of  the  room  moist,  wring 
some  towels  out  of  hot  water  and  hang  them  on  chairs 
or  ropes  stretched  across  the  room.  Keep  the  child  in 
this  room  and  moist  atmosphere  for  the  next  few  days. 
He  may  have  another  attack  the  same  night,  or  for  the 
next  two  or  three  nights.  He  should  be  given  a  cathartic, 
and  his  diet  should  be  reduced.  If  he  is  not  relieved 
after  vomiting,  and  the  breathing  is  not  improved,  be 
sure  to  send  for  a  physician  at  once. 

EAR-ACHE 

Causes. — Ear-ache  often  follows  coughs  and  colds 
in  the  head,  influenza  (grippe),  pneumonia,  measles,  etc., 
and  may  be  present  in  any  run-down  condition. 

Symptoms. — Infants  suffering  from  ear-ache  have 
fever,  and  show  a  high  temperature,  102°-105°F.,  are 
restless  or  drowsy,  have  little  appetite,  and  may  vomit. 
They  may  move  the  hand  up  to  the  ear,  and  usually  toss 
the  head  from  side  to  side  violently.  Children  old 
enough  to  talk  naturally  complain  of  the  pain  and  show 
the  above  symptoms  as  well. 

Treatment. — A  physician  should  be  consulted,  as 
in  many  cases  incision  of  the  drum  is  necessary,  and  will 
give  immediate  relief.  In  the  meantime  heat  should  be 
applied  to  the  ear  in  the  form  of  hot  compresses,  a  bag 
containing  hot  salt,  or  a  hot  water  bottle.  The  ear  should 
also  be  irrigated  with  a  hot  boric  acid  solution,  one  tea- 


110  HOW  TO  TAKE  CARE  OF  THE  BABY 

spoonful  to  the  pint,  from  a  fountain  syringe  suspended 
or  held  two  feet  above  the  child's  ear.  The  nozzle  should 
be  held  from  one-quarter  to  one-half  inch  from  the  open- 
ing in  the  ear.  This  process  should  be  repeated  every 
three  or  four  hours.  If  the  ear  is  already  discharging, 
it  should  be  irrigated  at  least  three  times  a  day  until  no 
more  pus  is  seen.  The  length  of  time  that  an  ear  dis- 
charges varies  very  much.  If  the  drum  is  opened  early 
by  a  physician  the  discharge  may  stop  in  a  week,  and 
seldom  lasts  longer  than  three  weeks.  When  the  drum 
has  burst  of  its  own  accord  the  discharge  may  continue 
for  many  weeks. 

SPRUE  OR  THRUSH 

Cause. — ^When  an  infant's  mouth  or  feeding  uten- 
sils are  not  kept  perfectly  clean  he  is  apt  to  get  sprue  or 
thrush.  This  consists  of  a  minute  fungus  growth,  which 
thrives  on  the  tongue  and  inner  sides  of  the  cheeks,  but 
may  spread  to  the  throat.  Sprue  has  the  appearance  of 
small  particles  of  curdled  milk,  each  about  the  size  of  a 
pin's  head.  Any  attempt  to  wipe  them  off  will  cause 
slight  bleeding. 

Symptoms. — It  usually  occurs  in  a  bottle-fed  baby, 
and  the  first  symptoms  noticed  are  loss  of  appetite,  re- 
fusal to  take  the  bottle,  and  peevishness,  the  reason  for 
this  being  that  the  mouth  is  sore  and  sucking  is  painful. 

Treatment. — The  treatment  is  simple.  The  bottle 
and  nipples  must  be  kept  clean.  A  solution  of  one  tea- 
spoonful  of  soda  bicarbonate  to  three  ounces  of  water 
should  be  rubbed  on  all  the  w^hite  spots.  To  one  end  of 
a  piece  of  wood  a  little  smaller  in  diameter  than  an  ordi- 
nary lead  pencil  attach  a  little  absorbent  cotton  and  twist 
it  round  to  make  a  swab.  This  is  better  than  using  a 
finger.  The  mouth  should  be  treated  in  this  way  after 
each  feeding.    The  spots  disappear  in  about  a  week.  The 


A    MOTHER'S    GUIDE  111 

amount  of  sugar  in  the  child's  food  should  be  reduced 
by  one-half  for  the  next  week. 

ENLARGED  GLANDS 

Glands  of  the  Neck. — The  glands  of  the  neck  be- 
hind and  under  the  jaw,  and  below  the  ear,  often  swell 
to  a  large  size.  This  is  always  caused  by  some  infec- 
tion, and  may  be  due  to  one  of  the  contagious  or  in- 
fectious diseases,  influenza  or  catarrh,  malnutrition  or 
marasmus,  decayed  teeth,  or  enlarged  tonsils.  When 
glands  have  existed  for  a  long  time,  tuberculosis  may  be 
the  cause. 

Sometimes  the  child  is  otherwise  perfectly  well,  and 
the  glands  appear  quite  suddenly.  In  the  majority  of 
cases  these  sudden  swellings  are  not  in  any  way  serious ; 
they  often  disappear  gradually.  Occasionally  they  break 
down  and  require  incision  to  let  the  pus  escape ;  but  this 
is  a  simple  matter  and  recovery  is  complete. 

It  is  always  advisable  to  consult  a  physician  in  regard 
to  these  cases. 

ADENOIDS 

Adenoids  are  soft,  glandular,  whitish  masses  which 
grow  on  the  roof  of  the  pharynx  near  the  posterior  open- 
ing of  the  nostrils,  thus  obstructing  the  free  passage 
of  air. 

Symptoms. — There  are  few  conditions  that  are  re- 
sponsible for  more  disorders  than  adenoids.  During  the 
colder  months  of  the  year,  and  especially  in  moist  locali- 
ties near  the  sea  level,  children  with  adenoids  have  con- 
stant colds  in  the  head,  persistent  cough  and  recurring 
attacks  of  bronchitis. 

Adenoids  are  the  cause  of  children  snoring  at  night, 
also  of  restless  sleep  and  night  terrors.  Children  having 
large  adenoids  breathe  entirely  through  the  mouth,  and 


112  HOW  TO  TAKE  CARE  OF  THE  BABY 

when  the  condition  has  existed  for  some  time  they  have 
a  vacant  and  stupid  expression,  with  the  lower  jaw 
drawn  down  and  a  pinched-looking  nose. 

Adenoids  are  often  responsible  for  deafness,  inflam- 
mation of  the  ears,  and  anemia,  and  they  predispose  to 
diphtheria  and  tuberculosis.  Stunted  growth,  backward- 
ness and  nervousness  are  directly  traceable  to  them. 

Treatment. — Prompt  removal  by  operation  is  the 
only  treatment.  The  operation  is  a  slight  one,  scarcely 
ever  attended  by  danger,  and  is  followed  by  immediate 
improvement. 

It  is  seldom  necessary  to  operate  on  children  imder 
one  year  old. 

TONSILS 

The  tonsils  are  two  soft  glands,  one  on  each  side  of 
the  throat,  near  the  base  of  the  tongue. 

Symptoms, — Large  tonsils  are  responsible  for  fre- 
quent inflammation  of  the  throat,  resulting  in  coughs, 
bronchitis,  tonsilitis,  anemia,  etc,  A  child  with  large 
tonsils  is  more  susceptible  to  diphtheria,  scarlet  fever, 
tuberculosis  and  rheumatism. 

Treatment. — Children  with  large  tonsils  and  a  his- 
tory of  repeated  attacks  of  sore  throat  and  its  many  com- 
plications should  be  operated  on  for  removal  of  the  ton- 
sils. In  skilful  and  experienced  hands  the  operation  is 
seldom  dangerous. 

WORMS 

Varieties  of  Worms, — Worms  are  found  chiefly  in 
older  children,  nursing  babies  and  infants  being  practi- 
cally free  from  them.  The  most  common  varieties  are 
the  tapeworm,  the  roundworm  and  the  thread  or  pin- 
worm.  A  diagnosis  of  this  condition  can  only  be  made 
after  finding  the  worms  in  the  stools. 

Symptoms. — Symptoms  may  be  altogether  absent. 


A   MOTHER'S   GUIDE  113 

or  they  may  be  indefinite  or  misleading.  There  may  be 
bad  breath,  loss  of  appetite,  colic,  diarrhea,  anemia,  in- 
tense itching  of  the  anus,  and  various  nervous  derange- 
ments, such  as  headache,  dizziness,  etc. 

Tapeworm. — This  worm  is  from  ten  to  thirty  feet 
long  and  not  more  than  one-third  of  an  inch  wide  at  its 
widest  part.  It  is  composed  of  hundreds  of  small  seg- 
ments, and  is  flat  like  a  tape. 

Roundworm. — This  varies  in  length  from  four  to 
ten  inches  and  looks  very  much  like  the  ordinary  earth 
worm. 

Threadworms. — These  are  from  one-third  to  one- 
half  of  an  inch  long  and  look  like  small  pieces  of  white 
thread.  Although  the  worms  themselves  often  can  not 
be  found  in  the  stools,  their  eggs  can  nearly  always  be 
detected  with  the  aid  of  a  microscope. 

Treatment. — The  treatment  should  be  left  in  the 
hands  of  a  physician. 

NIGHT  TERRORS 

Symptoms. — It  is  not  at  all  unusual  for  young  chil- 
dren to  wake  up  suddenly  at  night,  crying  loudly,  and 
apparently  in  great  fear  of  some  one  or  something. 
They  are  quieted  with  difficulty,  and  for  a  few  moments 
hardly  seem  to  recognize  those  about  them.  These  at- 
tacks may  occur  with  great  frequency  or  only  at  long 
intervals. 

Causes  and  Treatment. — In  nearly  every  case  the 
cause  is  due  to  some  disturbance  of  the  digestive  tract. 
It  may  be  constipation  or  indigestion  following  over- 
eating or  eating  some  indigestible  food.  Occasionally 
worms,  or  enlarged  tonsils,  or  adenoids  may  be  respon- 
sible for  these  attacks. 

When  the  attack  is  due  to  indigestion  it  will  be  suffi- 
cient to  give  a  cathartic  and  regulate  the  diet  carefully, 


114  HOW  TO  TAKE  CARE  OF  THE  BABY 

particularly  as  regards  the  evening  meal,  which  must  be 
very  light.  This  usually  effects  a  cure.  During  the 
attack  treat  the  child  kindly ;  scolding  will  only  make 
him  worse. 

RETENTION  OF  URINE 

Cause. — The  most  common  cause  of  this  condition 
is  highly  acid  urine.  It  may  also  result  from  inflamma- 
tion of  the  genitals,  from  an  infection  or  from  want  of 
cleanliness.  In  boys  it  is  sometimes  due  to  inflammation 
and  marked  swelling  of  a  tight  foreskin,  which  has  never 
been  pushed  back,  and  under  which  a  lot  of  white,  pasty 
material  has  been  allowed  to  accumulate. 

Treatment. — If  no  water  has  been  passed  for  twelve 
hours,  place  the  child  in  a  hot  bath  at  a  temperature  of 
about  105 °F.  This  will  usually  have  the  desired  effect. 
If  not,  give  a  hot  enema  with  one  pint  of  hot  water  to 
which  one  teaspoonful  of  salt  has  been  added,  and  at 
the  same  time  put  a  hot  compress  over  the  region  of  the 
bladder  or  the  lower  part  of  the  belly.  Catheterization 
is  rarely  necessary,  and  should  be  done  by  a  physician 
only. 

In  boys  with  swollen  parts,  a  cold,  wet  dressing  with 
a  solution  of  boric  acid  should  be  applied  after  the  hot 
bath  or  enema,  and  if  the  swelling  does  not  diminish  after 
a  few  hours  of  these  applications,  a  physician  should  be 
sent  for. 

In  girls,  when  there  is  inflammation  of  the  parts,  a 
small  pad  of  cotton  or  linen  soaked  in  a  warm  solution 
of  boric  acid,  should  be  applied  and  changed  every  two 
hours,  after  gently  washing  the  parts  with  boric  acid 
solution.  If  the  inflammation  does  not  subside,  or  if  a 
yellow  discharge  is  noticed,  a  physician  should  be  noti- 
fied, as  it  is  very  contagious. 


A   MOTHER'S   GUIDE  115 

Parents  are  often  mistaken  as  to  the  amount  of  urine 
voided.  If  a  large  pad  of  absorbent  cotton  wool  is  placed 
over  the  genitals  and  examined  from  time  to  time,  they 
will  be  able  to  judge  the  amount  more  correctly. 

JAUNDICE 

About  one-third  of  children  born  become  jaundiced 
or  yellow  in  the  latter  part  of  the  first  week  of  their 
existence.  The  yellow  color  in  the  skin  is  most  marked 
on  the  face  and  chest  and  in  the  eyes.  The  color  lasts 
only  a  few  days  in  most  cases,  and  no  alarm  need  be  felt. 
No  treatment  is  necessary. 

THE  TEMPERATURE 

How  to  Take  the  Temperature. — Examine  the  ther- 
mometer and  see  that  the  mercury  is  below  97°F. ;  if  not, 
shake  it.  Oil  the  bulb  with  a  little  vaseline,  place  the 
child  with  his  stomach  on  your  lap  and  expose  the  but- 
tocks ;  separate  the  folds  with  one  hand  and  insert  the 
thermometer  gently  into  the  rectum  with  the  other  for 
about  an  inch  and  hold  it  there  for  from  one  to  two  min- 
utes, depending  on  the  kind  of  thermometer.  After  read- 
ing the  temperature,  wash  the  thermometer  in  cold  water 
and  soap.  It  is  well  to  shake  the  mercury  down  after 
use,  as  it  is  liable  to  be  forgotten  later  on  and  mistakes 
made.  When  a  child  is  sick  in  bed,  turn  him  over  on 
one  side  and  draw  his  thighs  up  and  proceed  as  before. 
The  temperature  is  normal  when  it  is  between  98°  and 
99y^°F.,  with  occasional  slight  fluctuations. 

A  separate  thermometer  should  be  kept  for  the  baby's 
use  and  not  used  for  other  children. 

High  Temperatures  in  Children. — It  must  be  re- 
membered that  slight  causes  often  produce  high  tempera- 


116  HOW  TO  TAKE  CARE  OF  THE  BABY 

ture  in  young  children  for  a  short  time,  and  that  this  is 
not  apt  to  be  so  serious  as  the  same  temperature  in  an 
adult.  Even  a  temperature  of  104°  need  not  cause  alarm 
unless  it  is  continued  for  more  than  a  few  hours  or  the 
child  shows  other  serious  symptoms  of  illness. 

Nervous  children  or  those  recovering  from  an  illness 
often  have  a  temperature  slightly  above  normal  for  days 
at  a  time. 

In  any  illness  accompanied  by  fever  the  temperature 
is  nearly  always  higher  toward  evening  than  in  the 
morning. 

In  fever  the  urine  is  always  scanty  and  highly  colored, 
staining  the  diapers  yellow  or  brick-red.  In  this  case 
the  child  requires  more  water  to  drink. 

Subnormal  Temperature. — When  the  temperature 
is  below  normal,  put  the  child  to  bed,  wrap  him  up  in 
warm  blankets  and  place  hot  water  bottles  at  his  feet 
and  at  the  sides  of  his  body.  If  possible,  give  him  a  cup 
of  hot  milk.  If  he  does  not  get  warm  soon,  give  him  a 
very  hot  saline  colon  irrigation. 

EXAMINATION  OF  THE  THROAT 

How  to  Examine  the  Throat. — A  mother  should  be 
able  to  examine  her  child's  mouth  and  throat  so  that  she 
may  recognize  any  abnormal  condition.  She  should  make 
a  practice  of  looking  at  them  from  time  to  time,  especially 
whenever  the  child  coughs  or  shows  any  signs  of  illness. 

The  child  should  be  held  by  the  nurse,  so  that  its  back 
rests  against  her  right  shoulder;  she  then  passes  her 
right  arm  around  the  child's  chest  and  holds  his  two 
arms,  while  her  left  arm  supports  his  body.  The  mother 
with  her  left  hand  steadies  the  child's  head  and  with  a 
tongue  depressor  or  spoon  opens  the  child's  mouth  gently, 
examines  the  tongue  and  gums,  and  then  depressing  the 
tongue  with  the  handle  of  the  spoon,  examines  the  throat. 


A   MOTHER'S    GUIDE 


117 


EXAMINING  THE  THROAT 


118  HOW  TO  TAKE  CARE  OF  THE  BABY 

If  no  second  person  is  available,  the  child's  arms  may 
be  controlled  very  efficiently  by  winding  a  folded  sheet 
about  its  arms  and  body  and  securing  it  with  a  safety-pin. 

TRAINING  OF  BOWELS  AND  BLADDER 

Training  of  Bowels. — The  training  of  a  child's 
bowels  should  begin  at  about  the  second  month,  and  can 
be  done  in  the  following  manner:  A  small  chamber  is 
placed  between  the  nurse's  knees,  and  on  this  the  baby 
is  seated,  taking  care  to  support  his  body  firmly  and  to 
brace  his  back  against  the  nurse's  chest.  At  first  it  may 
help  to  insert  a  little  cone  of  oiled  paper  or  a  small  stick 
of  soap  into  the  orifice  and  to  tickle  it  gently  for  a  few 
moments  previous  to  seating  him  on  the  chamber,  but 
after  a  short  time  this  will  not  be  necessary,  when  once 
the  habit  has  been  formed. 

Suitable  Hours. — As  a  normal  baby  has  from  one 
to  two  movements  a  day,  he  should  be  trained  to  have 
them  at  the  same  hours.  Twice  a  day,  immediately 
after  the  morning  and  afternoon  feedings,  is  the  most 
convenient.  If  this  is  kept  up  with  regularity,  and 
the  baby  is  in  good  health,  he  can  sometimes  be  trained 
in  this  respect  as  early  as  the  age  of  three  months.  The 
comfort  of  fomiing  this  habit  at  the  earliest  possible 
age  will  be  readily  appreciated,  as  it  means  a  great  sav- 
ing of  labor ;  and  it  is  also  beneficial  to  the  child's  health, 
as  it  will  be  conducive  to  regular  movements  of  the 
bowels  throughout  childhood. 

Training  of  Bladder  in  Daytime. — The  training  of 
the  bladder  is  not  so  easily  accomplished,  but  a  great  deal 
can  be  done  by  the  practice  of  holding  a  child  over  the 
chamber  about  a  dozen  times  a  day.  In  many  cases  this 
is  so  successful  that  by  the  end  of  the  first  year  diapers 
can  be  dispensed  with  entirely  during  the  child's  waking 
hours. 


A   MOTHER'S   GUIDE  119 

Bed  Wetting-. — At  night,  a  child's  bladder  is  rarely 
under  his  control  until  he  has  reached  the  age  of  two 
and  a  half  or  three  years.  After  three  years  bed-wet- 
ting may  be  considered  abnormal,  but  is  of  frequent 
occurrence.  It  is  very  seldom  a  symptom  of  any  blad- 
der or  kidney  trouble,  but  the  most  frequent  causes  are 
acidity  of  urine,  malnutrition,  bad  condition  of  the  nerv- 
ous system,  heredity,  constipation  and  local  irritation. 
Once  it  has  become  a  settled  habit  and  the  child  has 
reached  the  age  of  five  or  six  years  it  is  difficult  to  cure, 
unless  the  cause  should  be  entirely  local,  such  as  tight 
foreskin,  etc.,  when  a  physician  should  be  called  upon  to 
remedy  the  condition. 

Regime  to  be  Followed. — Attention  should  be  paid 
to  the  child's  general  condition  and  to  the  state  of  his 
nerves.  One  should  also  be  particular  to  keep  him  on  a 
simple,  nourishing  diet  and  not  to  allow  him  any  excite- 
ment.   His  urine  should  be  examined  by  a  physician. 

No  Water  or  Milk  After  4  p.  m. — In  addition  to 
this  he  should  be  given  plenty  of  fluid  early  in  the  day, 
but  none  whatever  after  4  p.  m.,  receiving  a  dry  supper 
before  going  to  bed.  He  should  be  taught  to  hold  his 
urine  as  long  as  possible  during  the  day,  in  order  to 
accustom  the  bladder  to  full  distension. 

Cold  Hip  Bath. — Just  before  bedtime  his  buttocks 
and  genitals  should  be  immersed  in  cold  water  for  a  min- 
ute or  two  and  the  spine  should  also  be  sponged. 

Sleeping  on  Side. — The  bed  covering  should  be 
fairly  light,  and  the  child  should  be  encouraged  to  sleep 
on  his  side  and  not  on  his  back.  This  can  be  done  by 
tying  a  piece  of  thin  material  about  the  chest  with  a  knot 
on  the  back  between  the  shoulders.  At  10  p.  m.  or  11 
p.  m.  every  night  he  ought  to  1)e  taken  up. 

Some  Cases  Resist  Treatment. — In  spite  of  all  these 
measures  there  are  some  children  who  still  continue  bed- 
wetting  until  nearly  up  to  puberty,  when  the  habit  will 


120  HOW  TO  TAKE  CARE  OF  THE  BABY 

cease  for  no  apparent  reason.  It  is  a  weakness  common 
to  both  sexes,  and  some  are  also  affected  with  sHght 
dribbhng  during  the  day. 

Punishments  and  Rewards. — It  must  be  remem- 
bered that  at  night,  bed-wetting  is  often  almost  entirely 
involuntary.  Punishments  are  never  of  any  use.  On  the 
other  hand,  by  offering  rewards  and  appealing  to  a  child's 
pride,  more  will  often  be  accomplished ;  but  at  best  it  is 
a  very  difficult  habit  to  break  and  the  cure  usually  takes 
a  long  time. 

It  is  advisable  to  leave  the  treatment  in  the  hands  of  a 
physician. 

DEVELOPMENT 

Weight  of  average  normal  child: 
At  birth,  7^  lbs.,  more  or  less. 
At  1  week,  6^  lbs.,  losing  half  pound  until  mother's  milk 

secretes. 
At  10  to  14  days,  7}i  lbs.,  same  as  at  birth. 


At     1  month, 

At    2  months,  10^  lbs.    f-  Gain  about  6^  oz.  a  week. 

At    3  months, 


1,     8M  lbs.    1 

is,  \0y2  lbs.    ^Gaii 

IS,  12    lbs.    J 

] 

3S.     >' 
5.      J 


At  4  months,  13^  lbs. 

At  5  months,  14^^  lbs.   \  Gain  about  4_^4  oz.  a  week. 

At  6  months,  IS^^  lbs. 

At  7  months,  16>^  lbs. 

At  8  months,  17^4  lbs.   }"  Gain  about  3  oz.  a  week. 

At  9  months,  18    lbs. 


At  10  months,  18->4  lbs. 

At  11  months,  19>4  lbs.    j-Gain  about  2^  oz.  a  week. 

At  12  months,  20    lbs. 


A  MOTHER'S   GUIDE  121 

And  thereafter  five  pounds  a  year  for  every  year  until 
the  eleventh  birthday,  thus,  at 

2  years 25  lbs. 

3  years 30  lbs. 

4  years 35  lbs. 

5  years 40  lbs. 

6  years 45  lbs. 

7  years 50  lbs. 

8  years 55  lbs. 

9  years 60  lbs. 

10  years 65   lbs. 

1 1  years 70  lbs. 

For  the  next  three  years  a  child  gains  about  ten  pounds 
a  year,  thus,  at 

12  years 80  lbs. 

13  years 90  lbs. 

14  years 100  lbs. 

Most  mothers  expect  infants  to  gain  six  to  eight  ounces 

a  week  during  the  first  year,  and  this  often  leads  to 
overfeeding.  During  illness  children  lose  weight  very 
rapidly,  but  when  convalescent  they  often  regain  their 
weight  equally  rapidly,  as  much  as  six  to  eight  ounces 
a  week. 

Until  it  is  a  year  old  a  child  should  be  weighed  once 
a  week  at  a  fixed  hour,  most  conveniently  just  before  the 
bath.  Delicate  or  sick  children  should  be  weighed  twice 
a  week.  A  record  of  tlic  weights  should  be  carefully 
kept.  No  comparison  with  the  weights  of  other  people's 
babies  should  be  entertained,  as  no  two  babies  grow  up 
alike,  and  a  mother  should  not  be  discouraged  when  her 
baby  does  not  gain  in  weight  according  to  the  schedule. 
At  times,  especially  during  the  warm  summ.er  months, 
some  babies  gain  very  little  or  not  at  all,  but  they  are  not 
on  this  account  to  be  overfed.  A  continuous  increase  of 
seven  ounces  a  week  is  rare  and  is  apt  to  end  in  trouble. 
Gain  in  weight  is  often  arrested  by  trifling  disturbances 


122  HOW  TO  TAKE  CARE  OF  THE  BABY 

of  health,  as  slight  cough,  cold  in  the  head,  constipation, 
teething,  etc. 

Scales. — There  are  many  baby  scales  on  the  market 
at  a  reasonable  price,  from  three  dollars  and  a  half  up. 
Scales  consisting  of  a  basket  supported  on  springs, 
which  work  a  needle  on  a  dial,  are  not  reliable,  as  the 
springs  either  get  out  of  order  or  get  weaker  by  usage, 
besides  the  reading  of  the  weight  is  uncertain  whenever 


BABY  SCALE 


the  baby  Is  restless.  All  reliable  hardware  manufac- 
turers, such  as  Howe  or  Fairbanks,  have  a  variety  of 
suitable  scales  from  which  to  make  a  choice ;  they  should 
read  as  low  as  one-half  ounce. 

Height. — At  birth,  20  inches ;  at  6  months,  25  inches. 
One  year,  28^/2  inches,  a  growth  of  8j<^  inches  in  the  year. 

2  years,  32  inches,  a  growth  of  3^^  inches  in  the  year. 

3  years,  35  inches  ^ 

4  years,  38  inches   I  ^  ^^  ^f  3  ^^^^^^  -^^  ^^^ 

5  years,  41  mches    I 

6  years,  44  inches  ) 


A   MOTHER'S   GUIDE  123 

7  years,  46  inches  ^ 

8  years,  48  inches  I  ^    ^^^^^  ^f  2  inches  in  the  year. 

9  years,  50  inches  I 
10  years,  52  inches  ) 

Muscular  Development. — At  3  or  4  months  a  child 
can  hold  his  head  up  ;  at  4  or  5  months  he  laughs  aloud ; 
at  6  months  he  reaches  for  toys ;  at  6  or  7  months  he 
can  sit  erect ;  at  9  or  10  months  he  tries  to  get  on  his 
feet;  at  12  or  13  months  he  can  walk  alone;  at  14  or  15 
months  he  can  run  about. 

Speech. — At  1  year  a  child  can  use  single  words. 
At  2  years  a  child  can  use  short  sentences. 

Teeth. — A  child  has  20  milk  teeth  and  they  make 
their  appearance  as  follows: 

At     5  to    8  months 2  lower  central  incisors. 

At     8  to  12  months 4  upper  incisors. 

At  12  to  18  months 2  lower  lateral  incisors  and 

4  anterior  molars. 

At  18  to  24  months 4  canines. 

At  24  to  30  months 4  posterior  molars. 

General  development  is  often  delayed  by  neglect,  im- 
proper feeding,  sickness  and  other  causes,  such  as 
heredity. 

DENTITION  AND  CARE  OF  THE  TEETH 

Order  of  Appearance. — The  first  set  of  teeth  are 
twenty  in  number,  and  the  time  of  their  appearance  varies 
greatly  in  different  children,  but  the  following  is  the 
usual  order  of  their  arrival  at  various  ages : 

At  6  months    2  teeth 

At  1  year 6  teeth 

At  1^  years   12  teeth 

At  2  years   16  teeth 

At  2y2  years   20  teeth 


124  HOW  TO  TAKE  CARE  OF  THE  BABY 

Causes  of  Delayed  Dentition. — The  chief  causes  of 
'  delayed  dentition  are  rickets,  mahiutrition,  or  ill-liealth  of 
some  Ivind,  but  this  is  not  always  the  case  by  any  means, 
as  some  perfectly  healthy  children  are  very  late  in  teeth- 
ing, and  delayed  dentition  is  sometimes  a  family  trait. 
Nursing  infants  are  usually  earlier  than  the  artificially- 
fed  ones  in  their  dentition. 

Symptoms  of  Dentition. — It  is  a  common  mistake 
among  mothers  to  attribute  disturbances  of  the  digestive 
tract  in  infants  a  few  months  old  to  teething,  and  to  al- 
low the  symptoms  to  go  unchecked  for  this  reason;  one 
fallacy  being  a  widespread  belief  that  diarrhea  is  a 
favorable  condition  during  dentition.  Teething  is  very 
seldom  responsible  for  these  conditions  among  healthy 
bottle-fed  or  breast-fed  children.  These,  as  a  rule,  cut 
their  teeth  without  any  inconvenience  whatever.  In  a 
few,  dentition  will  be  accompanied  by  very  slight  symp- 
toms, such  as  loss  of  appetite,  irritability  and  restless- 
ness, slight  rise  in  temperature  about  100°  to  101°  F., 
slight  diarrhea,  occasional  vomiting,  and  less  than  the 
usual  gain  in  weight.  One  or  more  of  these  symptoms 
may  be  present,  and  the  child  is  noticed  to  drool  and  put 
his  fingers  in  his  mouth. 

Proper  Treatment. — The  mouth  should  be  carefully 
examined,  and  if  the  gum  is  found  to  be  swollen  and  in- 
flamed, that  part  should  be  gently  rubbed  with  the  finger 
three  or  four  times  a  day.  This  simple  measure  often 
relieves  the  pain  and  symptoms ;  but  care  must  be  taken 
to  wash  the  hand  carefully  before  inserting  a  finger  in 
the  baby's  mouth.  If  the  baby  is  breast-fed,  he  should  be 
given  an  ounce  of  water  before  nursing,  and  the  nursing 
period  shortened;  if  he  is  bottle-fed,  dilute  the  usual 
formula  one-quarter  to  one-half  with  water.  This  should 
be  continued  until  all  unfavorable  symptoms  have  sub- 
sided. 

Care  of  Teeth. — Until  the  age  of  two  years  a  child's 


A   MOTHER'S   GUIDE  125 

mouth  and  teeth  should  be  carefully  washed  two  or  three 
times  a  day  by  means  of  a  piece  of  absorbent  cotton 
twisted  around  a  toothpick,  or  the  little  finger,  and  dipped 
into  a  solution  of  boric  acid.  After  the  age  of  two  years, 
a  soft  toothbrush  and  castile  soap  should  be  used.  When 
a  child  is  three  years  old,  his  teeth  should  be  examined 
at  least  once  a  year  by  a  dentist. 

Permanent  Teeth. — The  permanent  teeth  appear  as 
follows : 

The  first  molars  (4)  at  6  years. 

The  incisors  (8)  at  7-8  years. 

The  bicuspids  (8)  at  9-10  years. 

The  canines  (4)  at  12-14  years. 

Second  molars  (4)  at  12-15  years. 

Third  molars  (4)  at  17-25  years. 

It  is  astonishing  what  little  attention  Is  paid  to  decayed 
teeth  in  children.  Defective  teeth  affect  the  health  of  the 
entire  body.  Decayed  or  irregular  teeth  interfere  with 
proper  mastication.  The  pus,  which  is  absorbed  from  de- 
cayed teeth,  poisons  the  system,  followed  by  nervous  dis- 
turbances due  to  pain,  indigestion  and  anemia.  Decay- 
ing teeth  act  as' a  breeding  ground  and  distributing  center 
for  bacteria,  which  cause  infectious  diseases. 

Above  all,  mastication  must  be  encouraged.  Without 
proper  mastication,  the  teeth  soon  begin  to  decay,  solely 
from  want  of  use.  The  food  must  therefore  be  of  such  a 
nature  that  it  can  not  be  swallowed  without  mastication. 

Most  children  do  not  nurse  after  the  ninth  month. 
Then  is  the  time  to  give  them  a  piece  of  toasted  bread  and 
butter  after  the  nursing  or  after  the  bottle,  twice  a  day. 
Children  will  gnaw  and  suck  the  toast,  and  this  action 
Induces  the  flow  of  saliva,  which  digests  the  starchy  food. 
True  mastication,  however,  does  not  take  place  until 
the  first  molars  appear,  about  the  fourteenth  month.  At 
two  and  a  half  years  of  age,  when  a  child  should  have 


126  HOW  TO  TAKE  CARE  OF  THE  BABY 

its  full  set  of  temporary  teeth,  it  can  eat  any  food  which 
adults  are  accustomed  to. 

The  meals  should  not  terminate  with  concentrated  or 
easily  fermentable  carbohydrates,  which  stick  about  the 
teeth,  such  as  bread  and  jam,  marmalade,  sweet  milk 
puddings,  or  other  foods  containing  a  large  amount  of 
sugar.  However,  if  these  things  are  eaten,  they  should 
be  followed  by  fresh  fruit.  An  apple  is  best  for  this 
purpose. 

The  pathological  craving  for  excess  of  sugar  results 
from  restricting  the  diet  to  pap.  Ninety-five  to  a  hun- 
dred per  cent,  of  children,  at  the  age  of  five  or  six  years, 
have  diseased  teeth  and  the  average  number  of  diseased 
teeth  in  each  mouth  is  about  nine.  At  fourteen  years, 
even  the  permanent  set  of  teeth  begins  to  decay,  so  that 
less  than  fifteen  per  cent,  of  children  at  that  age  are  free 
from  dental  caries. 

Not  many  years  ago,  it  was  supposed  that  dental  caries 
was  a  constitutional  disease  and  markedly  hereditary,  but 
now  it  is  known  to  be  almost  entirely  the  result  of  im- 
proper diet.  The  food  must  be  of  such  a  consistency  as 
to  demand  mastication  and  the  meal  must  be  finished  so 
as  to  leave  the  mouth  clean. 

Foods  can  be  divided  into  two  groups:  First,  those 
which  cling  about  the  teeth  and  leave  the  mouth  unclean ; 
and.  secondly,  those  which  are  cleansing  in  their  nature. 
In  the  first  group  we  include  all  starchy  and  sugary  foods, 
which  have  no  fibrous  element,  such  as  sweet  crackers, 
biscuits  and  cakes,  bread  with  marmalade,  jam,  or  honey, 
new  bread  without  crust,  bread  soaked  in  milk,  puddings, 
oatmeal  and  milk,  preserved  fruits,  chocolates  and  candy 
of  all  kinds.  Among  the  liquids  we  include  cocoa,  choco- 
late and  milk.  These  foods  are  not  harmful  in  moderate 
amounts,  except  when  taken  at  the  end  of  a  meal.  When 
taken  as  the  sole  food  for  a  meal,  they  do  not  contain  ma- 
terial of  the  right  consistency  for  proper  mastication. 


A   MOTHER'S   GUIDE  127 

In  the  second  group  we  have  the  cleansing  foods,  such 
as  fish,  meat,  bacon,  poultry,  uncooked  vegetables,  such 
as  lettuce,  cress,  radishes,  celery.  Cooked  vegetables  are 
cleansing  to  a  less  degree  than  uncooked  vegetables. 
Other  Articles  are  stale  bread,  toasted  bread,  twice  baked 
bread,  pulled  bread  and  cheese,  fresh  fruits  and  butter. 
Of  the  liquids  we  have  soups  and  beef  tea. 

Nothing  should  be  allowed  between  meals.  The  habit 
of  taking  candy  of  any  kind,  or  crackers  and  milk  be- 
tween meals  or  before  going  to  bed  is  injurious  to  the 
teeth  for  the  reasons  just  mentioned. 

It  is  impossible  to  give  adequate  directions  for  feeding 
children  even  of  the  same  age,  as  they  vary  so  much  in 
their  tastes  and  idiosyncrasies  and  their  constitutional 
tendencies.  Children  need  all  kinds  of  food,  and  in  suffi- 
cient quantities.  They  often  prefer  one  kind  of  food  to 
the  exclusion  of  others ;  some  care  to  eat  nothing  but  meat, 
others  make  their  meals  exclusively  of  cereals  or  veg- 
etables. Both  of  these  dietaries  are  wrong.  Children 
require  an  abundance  of  all  these  materials.  As  a  rule 
their  diet  is  deficient  in  fats.  Many  children  do  not  care 
for  the  fat  of  meats  or  for  butter,  which  makes  it  hard 
to  find  some  form  of  fat  that  will  be  acceptable.  Cream, 
the  fat  of  ham  or  bacon,  vegetable  oils,  nut  oils,  should  all 
be  given  a  trial. 

No  two  meals  should  be  alike.  Some  slight  change 
should  always  be  made.  Warmed  over  dishes,  smoked 
and  salted  meats,  thick  and  rich  gravies  should  be 
avoided.  Every  child  is  really  a  law  unto  himself,  and 
it  will  require  time,  patience  and  judgment  on  the  part 
of  the  mother  to  furnish  the  child  with  those  articles  of 
food  best  suited  to  his  special  requirements. 

N.  B. — At  two  years,  a  child  can  eat  an  apple  after  It  Is 
peeled  and  the  core  removed.  At  three  years,  he  can  eat 
an  unpeeled  apple,  but  the  core  must  be  removed. 


128     HOW  TO  TAKE  CARE  OF  THE  BABY 

VACCINATION 

As  a  precaution  against  smallpox,  every  child  should 
be  vaccinated  as  early  as  possible,  i.  e.,  during  the  first 
year.  Vaccination  should  never  be  delayed,  except  in 
cases  of  severe  illness  or  malnutrition.  When  properly 
carried  out  with  sterile  hands,  vaccine,  and  instruments, 
there  is  scarcely  any  danger. 

The  site  of  vaccination  is  a  matter  of  choice,  but  for 
the  sake  of  convenience,  in  dressing  and  undressing,  the 
leg  seems  to  be  the  best  place  for  an  infant. 

A  red  pimple  is  noticed  on  the  third  or  fourth  day, 
and  a  day  later  a  small  blister  is  seen,  which  enlarges 
during  the  next  three  or  four  days  to  about  one-third  of 
an  inch  in  diameter ;  it  is  gray  in  color  and  is  depressed 
in  the  middle.  The  blister  dries  up,  forming  a  crust, 
which  drops  off  in  a  week  or  two.  About  the  eighth  day 
a  bright  red  inflammation  of  the  skin  around  the  blister 
is  noticed,  which  disappears  in  a  few  days. 

Occasionally,  about  the  ninth  or  tenth  day,  there  may 
be  a  rash  somewhat  resembling  that  of  measles  or  scar- 
let fever. 

About  a  week  after  vaccination,  the  child  may  be  some- 
what restless,  and  have  a  little  fever  with  loss  of  appetite 
for  three  or  four  days. 

CIRCUMCISION 

This  small  operation  is  strongly  to  be  advised  when- 
ever the  foreskin  is  very  tight  or  very  long,  and  in  every 
case  when  it  can  not  be  pulled  back  with  ease.  The 
mother  or  nurse  should  pull  the  foreskin  back  two  or 
three  times  a  week  after  giving  the  bath  and  wash  the 
underlying  parts,  as  a  white,  pasty  material  will  accumu- 
late and  cause  irritation,  which  later  is  apt  to  lead  to 
self-abuse.    This  irritation  may  also  be  the  cause  of  bed- 


A   MOTHER'S   GUIDE  129 

wetting,  night  terrors  and  sleeplessness.  A  tight  foreskin 
is  sometimes  responsible  for  convulsions  on  account  of 
the  difficulty  in  passing  the  water,  and  if  the  latter  is 
accompanied  by  much  strr.ining,  this  may  cause  prolapse 
of  the  rectum,  i.  e.,  the  protrusion  of  the  lower  part  of 
the  bowels  or  hernia.  The  operation  is  very  simple  and 
attended  with  very  little  danger. 

THE  CRY 

Necessity  for  Crying. — At  birth  it  is  absolutely  nec- 
essary for  an  infant  to  cry,  in  order  that  air  may  enter 
the  lungs.  He  should  be  made  to  do  so  by  slapping  him 
on  the  buttocks. 

A  baby  should  cry  every  day  for  a  few  minutes,  for  by 
crying  the  lungs  are  kept  expanded.  (See  chapter  on 
Exercise.) 

The  Cry  of  Health  and  Illness. — It  is  not  an  easy 
matter  to  distinguish  between  the  cries,  but  a  mother  or 
nurse,  who  is  constantly  with  a  baby,  will  usually  learn 
to  tell  the  difference  between  the  cry  of  illness  or  pain 
and  the  usual  cry  in  health.  The  latter  is  a  strong,  loud 
cry,  and  the  child  gets  red  in  the  face.  The  cry  of  pain 
is  also  strong  and  loud,  but  is  not  continued  for  long,  and 
is  accompanied  by  other  evidences  of  distress,  such  as 
drawing  up  the  legs,  and  wrinkling  the  forehead. 

The  cry  of  illness  is  feeble  and  whining,  and  the  child 
shows  irritability  when  disturbed. 

The  cry  of  hunger  is  prolonged  and  fretful,  but  not 
very  loud. 

The  cries  of  temper  or  of  a  habitually  spoiled  child 
are  very  much  alike,  strong  and  violent,  and  cease  as 
soon  as  he  gets  what  he  wants.  In  these  cases  he  should 
be  allowed  to  cry  it  out,  and  no  harm  will  result  if  he  is 
in  good  health. 

Crying  at  Night. — When  a  child  cries  at  night,  see 


130  HOW  TO  TAKE  CARE  OF  THE  BABY 

that  his  hands  and  feet  are  warm,  and  examine  his  diaper, 
and  change  it  if  necessary, 

A  well  baby  seldom  or  never  cries  solely  because  of  a 
wet  or  soiled  napkin,  unless  his  buttocks  are  sore;  and  if 
the  crying  is  repeated  or  prolonged,  the  cause  is  usually 
some  digestive  disturbance.  It  is  then  advisable  to  give 
a  laxative  at  once,  and  to  reduce  the  strength  of  the  food 
the  next  day. 

Tears. — An  infant  does  not  shed  tears  until  the  age 
of  three  or  four  months.  Once  the  flow  of  tears  has  been 
established,  their  disappearance  in  crying  during  any  sick- 
ness is  not  a  favorable  sign.  On  the  other  hand,  their  re- 
appearance is  an  indication  of  improvement. 

KISSING  AND  PLAYING  WITH  BABIES 

Kissing. — The  kissing  of  an  infant  on  the  mouth 
should  never  be  permitted,  under  any  circumstances,  by 
either  adult  or  child.  Diphtheria,  tuberculosis  and  syphilis 
have  often  been  communicated  in  this  manner,  for  even 
healthy  adults  often  have  the  germs  of  these  diseases,  and 
although  they  may  never  suffer  from  them,  they  can 
communicate  them  to  a  baby.  Children  suffering  from 
contagious  diseases  in  their  earliest  stages  often  transmit 
the  disease  by  kissing. 

Infants  ought  never  to  be  kissed  by  any  one,  except 
on  the  forehead,  and  even  that  should  very  seldom  be 
permitted. 

Playing  with  Babies. — To  play  with,  or  amuse  an 
infant  under  the  age  of  six  months  is  actually  injurious, 
and  may  be  the  means  of  making  him  nervous  and  irrita- 
ble. Even  such  slight  amusements  as  swaying  a  baby,  or 
rocking  him,  all  tend  to  stimulate  the  rapidly  growing 
brain,  and  are  harmful  for  this  reason. 

Even  after  the  age  of  six  months,  it  is  wiser  to  let  an 


A   MOTHER'S   GUIDE  131 

infant  amuse  himself,  as  he  will  soon  learn  to  do,  if  left 
alone.  When  constant  efforts  are  made  to  amuse  a  child, 
he  is  apt  to  become  nervous  and  fretful,  to  sleep  badly, 
and  to  suffer  from  indigestion.  He  should  never  be 
played  with  imm-ediately  before  bedtime  at  any  age. 

The  practice  of  allowing  young  babies  and  children  to 
be  present  at  any  celebration  can  not  be  too  strongly  con- 
demned. The  gratification  of  showing  off  the  baby  and 
seeing  him  admired  is  not  worth  having  at  the  expense 
of  his  nerves  and  health. 

Children  of  Nervous  Parents. — The  children  of 
nervous  parents  need  to  be  especially  guarded  against  any 
excitement ;  they  should  have  quiet  surroundings,  and  see 
very  few  people.  Some  children  have,  undoubtedly,  a 
tendency  to  nervousness,  but  this  can  be  overcome  as 
ihey  grow  older  by  careful  and  intelligent  management. 

Older  Children.— Children  should  never  be  fright- 
ened, nor  should  they  have  harrowing  tales  told  to  them. 
As  soon  as  they  are  able  to  run  about,  all  their  amuse- 
ments should  be  out-of-doors  as  much  as  possible.  Romp- 
ing and  all  exciting  games  should  be  confined  to  the  early 
part  of  the  day,  so  as  not  to  interfere  with  their  sleep  at 
night.  Too  frequent  children's  parties,  especially  when 
indigestible  or  rich  food  is  given,  are  not  to  be  encouraged. 
Parties  should  be  in  the  daytime  only.  The  practice  of 
keeping  children  up  late  at  night  is  most  injurious. 

TOYS 

Selection  of  Toys. — In  buying  toys  for  infants,  care 
must  be  taken  not  to  select  anything  that  can  be  swal- 
lowed, as  most  children  have  a  natural  instinct  to  put 
everything  in  their  mouths.  For  young  babies  of  about 
six  months  of  age,  rubber  rattles,  animals  and  dolls  are 
the  best,  as  they  are  smooth  and  can  be  easily  washed. 


132  HOW  TO  TAKE  CARE  OF  THE  BABY 

No  toys  covered  with  wool  or  hair,  or  with  loose  pieces 
that  can  be  swallowed  or  put  in  the  ear  or  nose,  or  with 
sharp  points  to  injure  the  eyes,  or  paint  to  come  off, 
should  be  chosen  for  a  baby. 

Undesirable,  also,  are  those  that  can  be  broken  into 
bits,  or  those  that  would  be  apt  to  frighten  a  child  with 
sudden  noises  or  movements. 

All  toys  must  be  carefully  washed  before  giving  them 
to  a  baby,  and  the  washing  should  be  frequently  repeated 
afterward. 

Simple  Toys  the  Most  Desirable. — The  toys  that 
give  the  most  pleasure  are  the  simplest ;  and  this  is  true 
of  both  infants  and  older  children.  Elaborate  mechanical 
contrivances  fail  to  please  children  for  long.  They  soon 
tire  of  them  because  nothing  is  left  to  their  imagination. 

One  Toy  at  a  Time. — One  simple  toy  at  a  time  will 
give  a  child  more  opportunity  to  develop  his  own  re- 
sources for  amusement  than  a  large  number,  which  only 
bewilder  him.  As  soon  as  he  is  old  enough,  he  should 
be  taught  to  put  away  one  toy  when  he  takes  out  another, 
and  to  keep  all  those  not  in  use  neatly  in  a  closet. 

Toys  for  Older  Children. — For  older  children  the 
best  toys  are  the  ones  which  give  them  an  opportunity 
for  using  their  faculties  and  imagination  in  such  measure 
as  they  develop.  Toys  like  blocks,  toy-soldiers,  engines, 
picture-books,  dolls,  small  sets  of  dishes,  beads  to  string, 
and  pictures  to  paint  are  always  sources  of  enjoyment. 
Where  it  is  possible,  a  box  of  sand  from  which  different 
shapes  can  be  made,  will  give  children  a  great  deal  of 
pleasure. 

BAD  HABITS 

Below  are  mentioned  some  habits  often  seen  in  young 
children,  which,  if  not  corrected,  may  result  in  serious 
harm. 


A   MOTHER'S   GUIDE  133 

The  Pacifier. — ^The  pacifier,  or  rubber  nipple,  is  en- 
tirely unnecessary,  and  should  never  be  allowed.  Its  pro- 
longed use  is  harmful,  and  is  apt  to  be  followed  by : 

Thick,  misshapen  lips. 

Irregular  teeth. 

Deformed  palate. 

Adenoid  growths,  from  constant  irritation. 

Infection,  as  it  is  never  clean,  and  if  it  is  passed  around 
from  one  child  to  another,  it  may  carry  the  germs  of 
whooping  cough,  diphtheria,  etc. 

Thumb-sucking. — Some  children  are  also  addicted 
to  sucking  their  fingers,  or  any  objects  they  can  seize. 
This  habit  is  easily  remedied  by  folding  a  piece  of  card- 
board about  six  inches  broad  around  the  elbows,  so  that 
they  can  not  be  bent.  Secure  the  edges  with  adhesive 
plaster,  then  fold  a  piece  of  cheesecloth  or  old  linen 
around  the  cardboard  and  fasten  the  linen  above  and  be- 
low the  elbow  to  the  sleeve  by  means  of  safety-pins.  As 
the  child  can  not  bend  its  arms,  it  can  not  suck  its  fingers 
or  other  objects.  Special  mits  can  also  be  worn  over  the 
hands. 

Masturbation. — Masturbation  is  the  habit  of  irri- 
tating the  genitals.  This  is  done  in  various  ways,  by 
touching  them  with  the  fingers,  by  rubbing  the  thighs 
against  each  other,  and  by  rubbing  the  genitals  against 
the  leg  of  a  chair  or  table.  During  the  act  the  child's  face 
becomes  flushed  and  afterward  perspiration  may  be  no- 
ticed on  the  forehead  and  face.  This  is  followed  by 
drowsiness  and  the  child  may  go  to  sleep. 

Children  addicted  to  this  habit  show  nervous  symp- 
toms, they  are  restless,  irritable,  do  not  sleep  well,  lose 
their  appetite,  and  become  anemic. 

Treatment. — In  infants,  the  use  of  thicker  diapers 
that  will  keep  the  legs  well  apart  is  often  sufficient.  Older 
children  must  be  watched  carefully  during  the  day,  and  at 


134  '■  HOW  TO  TAKE  CARE  OF  THE  BABX 

night  when  going  to  bed.  If  thigh-rubbing  is  persisted  in, 
a  small  pillow  can  be  placed  between  the  knees,  and  fas- 
tened there.  J 

MILK  IN  INFANTS'  BREASTS 

New-born  infants  frequently  have  a  liquid  resembling 
milk  in  their  breasts.  This  must  be  severely  let  alone,  and 
it  will  disappear.  The  practice  of  squeezing  it  out  often 
causes  abscesses,  and  must  on  no  account  be  permitted. 

ACCIDENTS  ^ 

Foreign  Bodies  Swallowed. — Should  a  child  show 
signs  of  choking  after  swallowing  too  large  a  morsel  of 
food,  or  "swallow  the  WTong  way,"  as  it  is  sometimes 
called,  lift  him  up  by  the  legs  with  the  head  hanging 
down,  and  give  him  a  few  sharp  taps  on  the  back  with 
the  palm  of  the  hand.  This  will  dislodge  the  food.  When 
pins,  buttons,  coins,  etc.,  are  swallowed  do  not  give  a  ca- 
thartic, as  the  article  will  be  hurried  through  the  stomach 
and  bowels  with  a  possibility  of  causing  serious  injury. 
If  left  alone,  mucus  from  the  stomach  and  bowels  will 
collect  around  the  article  and  make  its  passage  smooth 
and  harmless.  If  this  accident  occurs  in  an  infant,  give 
the  same  food  as  usual,  and  if  an  older  child  give  more 
cereals,  mashed  potatoes,  etc.,  for  a  few  days.  Examine 
every  stool  carefully  for  the  article. 

Burns  and  Scalds. — When  the  burn  is  slight,  there 
is  redness,  pain  and  tenderness  of  the  skin,  which  is  not 
destroyed  in  any  way.  The  best  treatment  in  these  cases 
consists  in  the  application  of  wet  dressings  of  gauze  or 
old  linen  soaked  in  a  solution  of  bicarbonate  of  soda 
(cooking  soda),  a  heaping  teaspoonful  of  soda  to  the  pint 
of  water.  Boric  acid  solution  is  also  efficacious.  The 
dressings  should  be  kept  wet  continuously  with  either  of 


A  MOTHER'S   GUIDE  135 

tKese  solutions  to  prevent  their  adhering  to  the  burnt  sur- 
faces and  to  relieve  the  pain. 

In  very  severe  and  extensive  burns,  it  may  be  found 
necessary  to  place  the  child  in  a  tubful  of  v^rater  at  blood 
heat  98°  F.,  until  the  arrival  of  the  physician.  When  the 
burns  have  begun  to  heal,  and  the  discharge  to  disappear, 
they  may  be  dressed  every  day  or  two  with  sterile  or  clean 
boric  acid  ointment,  one  teaspoonful  to  an  ounce  of  vase- 
line. This  should  be  spread  thickly  on  gauze  or  linen  and 
the  dressing  secured  by  a  few  turns  of  a  bandage. 

Wounds. — Wounds  and  cuts  should  be  attended  to 
at  once.  Above  all  they  must  be  kept  clean,  and  should 
be  washed  at  once  in  warm  water  with  some  absorbent 
cotton  or  other  soft  material. 

Deep,  punctured  wounds,  from  nails,  broken  glass, 
splinters,  etc.,  require  thorough  opening  out  and  cleaning 
by  a  physician,  or  lockjaw  may  develop.  While  waiting 
for  his  arrival,  wash  the  wound  with  Dioxogen  and 
bandage  a  wet  compress  over  it.  When  there  is  much 
bleeding,  place  a  piece  of  absorbent  cotton  or  clean  linen 
over  the  wound  and  apply  firm  pressure  with  the  thumb 
or  finger,  until  the  bleeding  stops  and  the  cotton  adheres. 
Then  apply  a  light  bandage. 

Nose  Bleed. — Ice  cold  water,  sniffed  up  the  nostrils 
often  stops  bleeding.  Cold  compresses  held  over  the 
nose  and  the  back  of  the  neck  may  help.  If  this  does  not 
stop  it,  plug  the  bleeding  nostril  with  a  piece  of  absorbent 
cotton,  using  a  match  or  bit  of  wood  to  push  it  in.  If  this 
does  not  answer,  compress  the  lower  part  of  the  nose  be- 
tween the  thumb  and  forefinger  for  a  few  minutes.  The 
child  should  not  blow  its  nose  for  some  hours  after  the 
bleeding  has  stopped. 

Foreign  Bodies  in  Nose. — Compress  the  empty  nos- 
tril with  a  finger  and  get  the  child  to  blow  its  nose  ;  in  this 
way  most  objects  will  be  expelled.  If  not  successful  send 
^'otj  a  physician. 


136  HOW  TO  TAKE  CARE  OF  THE  BABY; 

In.  the  Ear. — No  attempt  should  be  made  to  remove 
objects  in  the  ear,  unless  they  can  be  easily  seized  with 
the  fingers.  It  is  better  to  await  the  arrival  of  a  physician, 
as  damage  may  be  done  to  the  canal  or  the  drum. 

In  the  Eye. — Rubbing  the  eye  makes  matters  worse. 
If  tears  collect  in  the  eyes,  wipe  them  toward  the  inner 
side.  Lay  the  child  on  a  bed  or  table,  separate  the  eyelids 
with  both  hands,  and  let  a  second  person  drop  some  warm 
water  from  a  piece  of  cotton  or  linen  on  the  eyeball,  or  let 
the  child  use  an  eyecup  or  put  its  face  in  a  basin  of  clean 
water  and  then  open  and  shut  the  eye  repeatedly. 

An  eyestone,  which  can  be  obtained  at  any  drug  store, 
is  often  useful  in  removing  objects  from  the  eye. 

Bruised  Fingers.— Apply  iced  or  very  hot  com- 
presses, and  bandage  the  fingers  tightly. 

Stings  of  Insects. — Apply  a  few  drops  of  ammonia, 
or  a  compress  soaked  with  witch  hazel  or  alcohol. 

Sunburn. — Apply  cold  cream  or  talcum  powder; 
or,  if  severe,  compresses  soaked  with  witch  hazel,  or  alco- 
hol diluted  with  an  equal  amount  of  water. 

CONVULSIONS 

Convulsions  in  infants  are  not  at  all  uncommon.  They 
are  symptoms  brought  on  by  irritation  of  the  brain  or 
nervous  system.  Although  very  alarming,  they  seldom 
leave  any  permanent  ill-effects. 

Causes. — Disturbances  of  digestion  are  the  most 
frequent  causes. 

The  next  most  frequent  cause  is  rickets. 

Convulsions  also  occur  at  the  onset  of  acute  febrile  dis- 
eases, such  as  pneumonia,  scarlet  fever,  etc. 

Whooping  cough,  especially  in  young  infants,  is  nearly 
always  accompanied  by  convulsions. 

Local  irritation,  such  as  burns,  tight  foreskin,  etc.,  may 
bring  on  convulsions. 


A   MOTHER'S   GUIDE  137 

Convulsions  from  teething  or  worms  are  very  rare 
indeed. 

Symptoms. — As  a  rule  a  convulsion  comes  on  with- 
out warning.  The  child  becomes  unconscious,  the  eyes 
vacant  and  fixed,  or  rolled  up,  the  face  becomes  pale,  the 
hands  are  clenched,  and  the  muscles  of  the  face,  arms  and 
body  begin  to  twitch.  The  child  breathes  feebly,  the 
forehead  is  cold  and  wet,  and  the  lips  and  finger  tips  may 
turn  blue.  The  convulsion  may  last  from  a  few  seconds 
to  many  minutes.  After  the  attack  the  child  is  very  weak 
and  prostrated.  One  convulsion  is  apt  to  be  followed  by 
others. 

Treatment. — In  all  cases  a  physician  should  be  sent 
for  at  once.  When  the  convulsion  is  due  to  indigestion, 
rickets,  whooping  cough,  or  local  irritation,  the  child 
should  be  placed  immediately  in  a  hot  bath.  The  tempera- 
ture of  the  water  should  not  be  over  105°  F.,  or  as  hot  as 
can  be  comfortably  borne  by  the  mother's  arm.  If  mustard 
is  at  hand,  dissolve  a  tablespoonful  in  a  cup  and  add  it  to 
a  small  tub  of  water  or  to  six  inches  of  water  in  a  large 
bath-tub.  Hold  the  child  in  the  water  from  five  to  ten 
minutes,  meanwhile  gently  rubbing  his  body  and  limbs. 
Put  a  small  towel  dipped  in  cold  water  on  his  head  and 
forehead.  After  the  bath  dry  him  gently  but  quickly,  put 
him  to  bed  wrapped  in  warm  blankets,  and  keep  him 
warm  by  the  use  of  hot  water  bottles,  then  give  him 
an  enema  or  colon  irrigation  with  warm  soap  suds. 

If  the  convulsion  occurs  in  the  course  of  some  illness 
where  there  is  high  fever,  put  a  cold  compress  on  the 
child's  head  and  gently  sponge  the  body  and  limbs  with 
cool  water.  Place  a  hot  water  bottle  near  the  feet  if  they 
are  cold,  but  do  not  put  too  much  clothing  over  the  child. 

In  all  cases,  a  good  dose  of  castor  oil  should  be  given 
after  the  bath  or  sponging,  after  the  child  recovers  con- 
sciousness. 

After  Treatment. — Only  water  should  be  given  for 


138  HOW  TO  TAKE  CARE  OF  THE  BABY 

the  next  three  or  four  hours,  and  for  the  next  twenty- 
four  hours  the  child  should  have  no  other  food  excepting 
broths,  barley  water,  or  milk  greatly  diluted.  His  regular 
diet  must  be  resumed  very  gradually. 

COMMON  DISEASES  OF  CHILDHOOD 

The  following  diseases  are  described  for  the  con- 
venience and  benefit  of  mothers  and  nurses  who  happen 
to  be  in  the  wilds  or  in  uncivilized  countries,  where 
proper  medical  advice  can  not  be  obtained  without  great 
delay.  Those  living  in  civilized  communities  should  on 
no  account  attempt  to  treat  these  diseases  themselves. 

RICKETS 

This  is  a  chronic  disease  due  to  faulty  nutrition  which 
chiefly  affects  the  bones,  and  occurs  in  infants,  especially 
between  the  ages  of  six  months  and  two  years. 

Causes. — The  great  majority  of  cases  are  due  to 
prolonged  feeding  on  proprietary  foods  with  an  insuffi- 
cient amount  of  fresh  milk.  Less  frequent  causes  are 
fresh  milk  or  food  containing  an  insufficient  amount  of 
fat  or  cream.  In  rare  cases,  it  can  be  attributed  to  exces- 
sive fat  or  cream  in  the  food,  or  to  prolonged  use  of 
boiled  or  sterilized  milk. 

Early  Symptoms. — The  earliest  symptoms  are  fret- 
fulness,  pallor,  sleeplessness,  and  sweating  of  the  head ; 
the  pillow  is  constantly  wet,  and  the  hair  at  the  back  of 
the  head  is  worn  off  from  restlessness. 

Later,  the  abdomen  becomes  enlarged ;  this  is  known  as 
"pot-belly" ;  the  child  is  backward  in  development ;  either 
it  can  not  sit  erect,  or  its  teething  is  delayed  or  it  is  late 
in  walking. 

Later  Symptoms. — When  this  condition  is  neglected, 
many  bones  become  enlarged  and  deformed,  and,  as  the 


A   MOTHER'S    GUIDE  139 

bones  are  very  soft,  a  child  often  becomes  bow-legged. 
The  head,  the  wrists  and  ankles  are  enlarged  and  the 
chest  is  deformed.  There  may  be  convulsions  and  child- 
crowing.  The  child  is  usually  constipated,  and  is  subject 
to  frequent  colds  and  intestinal  troubles. 

Treatment. — Stop  all  proprietary  foods,  condensed 
milk,  etc.,  and  give  good,  fresh,  whole  milk  in  formulas 
suitable  to  his  age.  Add  albumen  water,  fresh  eggs, 
broths  and  beef-juice  to  the  diet  if  the  child  is  old  enough. 
Give  cod-liver  oil  emulsion,  or  the  juice  of  fried  bacon. 
See  that  the  child  has  plenty  of  fresh  air,  and  keep  him 
out-of-doors  as  much  as  possible.  Attend  to  the  regu- 
larity of  his  bowels,  and  give  suitable  cathartics  and 
enemas,  if  necessary. 

SCURVY 

Scurvy  is  a  disease  which  occurs  principally  between 
six  and  eighteen  months  of  age,  but  is  most  common  be- 
tween the  seventh  and  tenth  months.  It  usually  attacks 
the  knee  and  ankle  joints,  causing  great  pain. 

Causes. — The  chief  cause,  in  most  cases,  is  the  ex- 
clusive use  of  proprietary  foods  without  the  addition  of 
fresh  milk.  A  prolonged  use  of  pasteurized,  boiled,  or 
sterilized  milk  or  condensed  milk  is  also  a  frequent  cause. 

Earliest  Symptoms. — The  earliest  symptom  noticed 
is  that  the  child  cries  when  moved  or  taken  up,  or  the 
diaper  is  changed,  or  when  any  one  touches  the  bed  or 
bedclothes.  The  knee  and  ankle  joints  may  be  swollen 
and  are  very  tender,  but  are  not  hot  nor  red.  The  disease 
may  attack  any  joint  in  the  body,  but  the  knee  is  the  one 
most  commonly  affected.  The  mother  is  liable  to  mistake 
scurvy  for  the  result  of  an  injury,  rheumatism,  or  for 
paralysis,  as  a  child  suffering  from  this  disease  is  un- 
willing to  move  because  of  the  pain  caused  thereby,  but 
the  paralysis  is  only  apparent,  not  real.    Rheumatism  is 


140  HOW  TO  TAKE  CARE  OF  THE  BABY 

practically  unknown  in  children  under  two  years 
of  age. 

Other  Symptoms. — The  position  of  a  child  with 
scurvy  is  often  very  characteristic.  He  will  lie  on  his 
back  with  the  knees  slightly  drawn  up  and  widely  sep- 
arated. H  he  has  any  teeth,  the  gums  may  be  swollen 
and  purplish  in  color  and  will  bleed  easily.  The  child 
looks  pale  and  anemic  and  has  little  appetite  owing  to  the 
pain  caused  by  sore  gums. 

There  may  be  bluish  marks  resembling  bruises  on  dif- 
ferent parts  of  the  body,  especially  the  legs.  In  some 
cases  there  is  bleeding  from  the  nose  and  bowels. 

Treatment. — The  child  must  have  fresh  cow's  milk, 
and  also  the  juice  of  sweet  oranges  or  prune  juice,  begin- 
ning with  one-half  ounce  three  times  a  day,  one  hour  be- 
fore feedings,  and  increasing  the  amount  in  a  few  days 
to  one  and  a  half  ounces  three  times  a  day,  irrespective  of 
the  age.  H  he  is  old  enough  he  should  be  given  in  addi- 
tion mashed  or  baked  potatoes  and  apple  sauce  once  a  day. 

If  this  treatment  is  carried  out,  marked  improvement 
will  be  noticed  in  a  few  days,  and  a  cure  will  be  effected 
in  two  or  three  weeks  in  the  milder  cases. 

PNEUMONIA 

Causes. — Pneumonia  is  an  inflammation  of  the  lungs 
and  is  brought  about  by  exposure  to  cold  and  wet,  or 
whenever  the  vitality  of  the  body  is  lowered,  as  in  malnu- 
trition or  marasmus,  or  it  may  follow  a  neglected  or 
severe  bronchitis,  or  as  a  sequence  to  one  of  the  con- 
tagious diseases,  as  measles,  etc. 

Symptoms. — There  is  rapid  and  shallow  breathing, 
often  accompanied  by  a  grunt  at  each  expiration,  which 
is  very  characteristic.  There  is  a  hacking  dry  cough, 
which  may  be  very  distressing.  The  face  is  flushed,  the 
lips  are  blue  and  sometimes  we  may  see  fever  sores  (or 


A  MOTHER'S  .GUIDE  141 

herpes)  on  them.  The  tongue  is  coated,  the  skin  dry  and 
the  urine  scanty.  The  child  is  drowsy  and  may  be  dehri- 
ous.    The  temperature  varies  from  102°  to  105°  F. 

Treatment. — The  child  must  be  put  to  bed  at  once 
in  a  light  and  airy  room,  and  the  temperature  kept  be- 
tween 55°  and  60°  F.  The  windows  must  be  opened 
enough  to  admit  fresh  air,  but  without  a  draft.  The  bed 
clothing  should  be  very  light,  just  enough  to  keep  the 
child's  body  and  feet  warm  ;  a  great  deal  of  harm  is  often 
done  by  overloading  the  bed  with  blankets  and  quilts, 
which  make  the  child  restless  and  irritable  and  deprive 
him  of  sleep  and  rest.  If  he  perspires  about  the  head  and 
neck,  he  has  too  many  clothes  over  him.  The  diet  should 
be  fluid  only.  His  usual  bottle  of  milk  must  be  diluted 
with  one-quarter  to  one-half  water.  He  should  have 
plenty  of  cool,  but  not  iced  water  to  drink  between 
feedings. 

If  breast-fed,  he  should  be  nursed  as  before  and  should 
get  plenty  of  water  between  nursings.  His  bowels  must 
be  kept  open,  for  it  is  important  for  them  to  move  freely 
every  day.  It  is  well  to  give  a  good  dose  of  calomel  at 
the  commencement  of  the  disease  and  subsequently  an 
enema  of  soap  suds  if  necessary. 

Sponging, — If  the  child  is  very  restless,  he  should 
be  sponged  from  head  to  foot,  with  a  mixture  of  half 
alcohol  and  half  tepid  water,  taking  about  fifteen  minutes 
to  go  over  the  whole  body,  and  sponging  one  part  at  a 
time,  leaving  the  rest  of  the  body  covered.  This  sponging 
should  be  repeated  every  four  hours  if  the  child  is  very 
restless.  In  addition  an  ice  cap  should  be  laid  on  the  head. 

If  the  child  is  quiet,  but  the  temperature  is  high,  i.  e., 
over  104°  F.,  put  an  ice  cap  on  the  head  and  give  plenty 
of  fluids  to  drink,  and  leave  him  undisturbed.  Wet  com- 
presses may  be  used  instead  of  the  ice  cap,  but  must  be 
wrung  out  carefully  so  as  not  to  wet  the  pillow  and  the 
bedding. 


142  HOW  TO  TAKE  CARE  OF  THE  BABY 

Most  children  do  not  require  medicines,  unless  compli- 
cations arise,  which  should  be  attended  to  by  the  family 
physician. 

THE  SICK  ROOM  IN  CONTAGIOUS  DISEASES 

Quarantine. — The  room  selected  for  a  child  suffer- 
ing from  any  contagious  disease  should  be,  if  possible,  sit- 
uated on  the  top  floor,  as  there  he  can  be  more  rigidly 
isolated,  and  the  risk  of  infection  for  other  members  of 
the  family  will  be  much  less. 

Only  the  attending  nurse  and  the  physician  should  be 
allowed  in  the  room ;  other  members  of  the  family  must 
not  be  permitted  to  enter.  Any  children  in  the  family 
who  have  been  exposed  to  the  contagion  at  the  beginning 
of  the  illness  should  be  quarantined  in  another  part  of 
the  house  until  the  period  of  incubation  is  past ;  those  not 
exposed  should  be  sent  away  from  home. 

Room  and  Furnishings. — The  room  should  be  large, 
light,  and  well  ventilated,  and  it  will  be  better  to  have  an- 
other smaller  adjoining  room  set  apart  for  the  nurse  to 
change  her  clothes  in,  before  going  out  to  take  her  daily 
exercise,  and  also  in  the  event  of  a  second  nurse  being 
necessary.  An  open  fire  in  the  sick  room  is  very  desira- 
ble, when  possible,  also  green  shades  at  the  windows  so 
that  the  light  may  be  subdued  if  the  patient's  eyes  are 
weak.  All  carpets,  curtains,  draperies,  pictures,  orna- 
ments and  upholstered  furniture  should  be  removed,  and 
nothing  allowed  to  remain  that  can  not  be  burned  or 
washed  and  thoroughly  fumigated  afterward,  A  per- 
fectly bare  floor  without  any  rugs  is  best. 

Care  of  Room. — The  temperature  should  be  regu- 
lated to  68°  F.  by  day,  and  from  60°  to  65°  at  night. 
Ventilate  very  frequently,  covering  the  patient  with  extra 
blankets  while  doing  so,  or  better,  if  the  child  can  be 


A   MOTHER'S   GUIDE  143 

properly  shielded  from  drafts,  keep  the  windows  wide 
open  day  and  night,  except  when  changing  the  bedclothes 
or  other  coverings.  The  room  should  be  kept  very  clean 
by  wiping  with  damp  cloths,  which  must  be  burned  im- 
mediately after,  the  woodwork  and  furniture  should  be 
wiped  daily  with  a  solution  of  bichloride  of  mercury  in 
the  proportions  of  one  to  five  thousand.  One  tablet  of 
seven  and  one-third  grains  and  dissolved  in  two  and  one- 
half  quarts  of  water  will  make  this  solution. 

Precautions. — The  meals  for  patient  and  nurse  must 
be  left  outside  the  door  on  a  tray  for  the  nurse  to  take  in 
afterward,  and  after  use,  all  the  utensils  should  be  placed 
in  boiling  water  for  five  minutes  before  being  taken 
down-stairs. 

If  the  case  is  one  of  scarlet  fever  or  diphtheria,  the 
nurse  should  use  an  antiseptic  gargle  and  nasal  spray  to 
guard  herself  from  infection.  She  should  wear  a  cap 
completely  covering  her  hair  while  in  the  sick  room,  and 
all  her  clothes  should  be  of  cotton  and  washable.  She 
must  change  every  article  of  clothing  in  the  adjoining 
room,  and  wash  her  face  and  hands  thoroughly  before  de- 
scending for  her  daily  walk. 

Care  of  Linen. — In  place  of  handkerchiefs  for  the 
patient,  old  pieces  of  muslin  or  gauze  should  be  used  for 
the  purpose  of  cleansing  the  nose  or  mouth,  and  immedi- 
ately burned.  If  there  is  no  fire  in  the  room,  a  small  box 
or  bag  should  be  kept  to  put  them  in  and  this  sent  down 
to  the  furnace. 

All  clothing  and  bedding  both  for  patient  and  nurse 
should  be  soaked  in  carbolic  solution,  one  to  twenty,  and 
then  boiled  in  it  for  two  hours  before  going  to  the  laun- 
dry. The  practice  of  hanging  sheets  steeped  in  carbolic 
is  not  advisable,  as  carbolic  acid  poisoning  has  been 
known  to  result  from  it. 

The  chief  thing  to  be  remembered  in  connection  with 


144  HOW  TO  TAKE  CARE  OF  THE  BABY 

disinfection  is  scrupulous  cleanliness,  for  carbolic  and  bi- 
chloride are  effectual  only  when  they  follow  a  rigorous 
use  of  soap  and  water. 

Selection  of  Toys  and  Books. — All  toys  and  books 
for  use  during  the  child's  illness,  especially  if  it  be  scarlet 
fever,  must  be  of  a  character  that  can  be  burned  when 
the  child  is  convalescent.  A  goodly  supply  of  cheap  toys 
and  magazine  pictures  will  be  most  welcome,  for  when 
the  little  patient  is  not  very  ill  he  will  sleep  better  if 
propped  up  in  bed  occasionally  with  a  warm  dressing 
sacque  on,  and  allowed  to  amuse  himself  a  little,  but  in 
the  case  of  measles,  he  must  not  read  or  strain  his  eyes  in 
any  way. 

Fumigation. — After  measles  or  diphtheria,  it  is  not 
necessary  to  disinfect  so  thoroughly  as  after  scarlet  fe- 
ver; all  linen  and  clothing  should  be  treated  in  the  same 
manner,  but  a  thorough  cleaning  and  fumigation  of  the 
room  with  formalin  or  sulphur  is  all  that  is  necessary; 
formalin  is  the  best  disinfectant  for  a  room,  and  the 
generator  can  be  rented  with  full  directions  for  use  from 
almost  any  drug  store;  all  cracks  in  the  room  must  be 
previously  stopped  with  cotton,  and  larger  crevices  pasted 
with  paper.  The  room  should  be  left  overnight  under 
fumigation  and  then  thoroughly  aired. 

Fumigation  After  Scarlet  Fever. — A  child  conva- 
lescent from  scarlet  fever  must  receive  a  bichloride  bath 
one  to  five  thousand  strength,  from  head  to  feet,  before 
he  leaves  the  room;  he  should  then  be  wrapped  in 
blankets  and  taken  into  another  room,  where  he  is  given 
a  bath  of  soap  and  hot  water.  He  must  wear  clothes  that 
have  not  been  in  the  sick  room  during  his  illness. 

The  room  and  its  contents  should  receive  a  thorough 
fumigation  in  the  following  manner:  The  mattress  and 
pillows  must  be  either  thoroughly  disinfected  by  steam 
or  where  this  is  not  possible,  they  must  be  burned.  All 
blankets  and  bedding  should  be  boiled  in  carbolic  solu- 


A   MOTHER'S   GUIDE  145 

tion,  washed,  and  hung  in  the  sun.  All  toys,  books,  pa- 
pers, rugs,  etc.,  that  have  been  used  should  be  burned. 
The  room  and  all  the  furniture  in  it  must  be  thoroughly 
washed,  and  then  fumigated  with  formalin,  and  left  for 
twenty-four  hours.  After  this  the  ceiling  should  be  re- 
kalsomined  and  the  walls  repapered,  or  if  they  are 
painted,  washed  with  bichloride  solution  of  one  to  two 
thousand  strength.  (One  tablet  of  seven  and  one-third 
grains  to  one  quart  of  water.) 

CONTAGIOUS  DISEASES 

I  shall  describe  only  briefly  the  more  common  con- 
tagious diseases  met  with  in  children ;  such  as  scarlet 
fever,  measles,  whooping  cough,  diphtheria,  mumps,  etc. 

A  correct  diagnosis  is  sometimes  very  difficult,  even 
for  a  physician.  For  instance,  a  scarlatinal  rash  on  the 
abdomen  may  be  called  a  simple  stomach  rash ;  and  with- 
out laboratory  examination,  a  mild  form  of  diphtheria 
of  the  tonsils  may  be  mistaken  for  a  simple  follicular 
tonsilitis. 

The  onset  in  all  of  these  diseases  is  nearly  the  same, 
and  the  mother  should  not  waste  time  trying  to  find  out 
what  is  the  matter  with  the  child,  but  should  at  once  send 
for  a  physician. 

When  to  Send  for  a  Physician. — It  is  a  safe  rule  to 
make,  that  a  physician  should  be  sent  for  whenever  there 
is  a  rash,  a  sore  throat,  difficulty  in  swallowing,  a  cough 
with  difficult  breathing,  or  whenever  the  child  is  drowsy 
or  apathetic,  or  restless,  irritable,  and  has  loss  of  appetite. 

The  tem})erature  is  often  no  guide;  in  many  cases  of 
diphtheria  it  is  not  much  over  101°  F.  Nursing  infants 
under  six  months  of  age  who  are  properly  looked  after 
are  almost  immune  from  contagious  diseases,  with  the 
exception  of  whooping  cough. 


146  HOW  TO  TAKE  CARE  OF  THE  BABY 

Whooping  Cough 

In  the  early  months  of  Hfe,  whooping  cough  is  by  far 
the  most  fatal  of  the  contagious  diseases.  The  period  of 
incubation  varies  from  one  to  two  weeks.  At  first  the 
disease  can  not  be  distinguished  from  an  ordinary  cough, 
but  after  ten  to  fourteen  days  the  whoop  develops  in 
older  children.  For  this  reason,  a  child  with  a  cough 
should  never  be  allowed  near  a  young  infant  indoors  or 
out,  nor  sleep  in  the  same  room. 

Symptoms.— During  the  paroxysms  of  coughing, 
the  characteristic  whoop  is  noticed,  there  is  great  diffi- 
culty in  taking  breath,  the  face  gets  red,  and  there  is  great 
prostration  afterward.  The  food  is  often  vomited. 
Young  infants  do  not  whoop,  but  cough  and  hold  their 
breath,  and  turn  very  blue  in  the  face,  and  they  may  have 
convulsions. 

Treatment. — ^There  is  no  specific  remedy  for  whoop- 
ing cough ;  a  physician  can,  however,  administer  a  vaccine 
or  prescribe  sedatives  and  greatly  relieve  the  patient. 
The  child  should  have  plenty  of  fresh  air  day  and  night. 
There  are  many  preparations  in  the  market  claiming  to 
relieve  and  shorten  the  course  of  the  disease,  which  may 
be  of  use  in  some  cases.  A  sea  voyage  shortens  the  dura- 
tion of  the  cough  by  several  weeks.  A  properly  fitted  ab- 
dominal belt  will  often  give  relief. 

Contact  with  other  children  should  be  avoide,d  until  the 
cough  has  completely  disappeared,  as  the  whoop  often 
returns  if  the  child  catches  cold. 

A  physician  should  decide  when  a  child  can  be  allowed 
to  go  among  other  children. 

A  child  suffering  from  whooping  cough  should  wear  a 
white  band  on  the  arm  or  across  the  chest,  marked 
"Whooping  Cough,"  whenever  he  goes  out  in  any  park  or 
playground. 


A   MOTHER'S   GUIDE  147 


Chicken  Pox 


This  is  a  mild  contagious  disease  which  appears  about 
two  weeks  after  exposure. 

Symptoms. — There  is  a  slight  fever  in  most  cases, 
100°-102°  F.,  and  the  child  does  not  feel  so  well  as  usual. 
The  rash  appears  on  the  first  day,  comes  out  in  crops  and 
is  most  abundant  on  the  trunk.  We  notice  widely  scat- 
tered pimples  in  various  stages  of  development,  and  vary- 
ing greatly  in  size ;  red  spots,  elevated  pimples,  little  blis- 
ters, and  later,  blackish  crusts.  A  few  are  always  found 
on  the  scalp,  and  one  or  two  in  the  mouth,  the  latter  being 
a  very  characteristic  location.  There  may  be  itching  of 
the  skin. 

Treatment. — No  special  treatment  is  necessary. 
Keep  the  child  quiet  in  bed  for  a  couple  of  days,  and 
empty  the  bowels.  The  undergarments  should  be  of  cot- 
ton, as  woolen  ones  increase  the  itching.  Carbolated 
ointment  rubbed  on  the  skin  will  allay  the  itching. 

The  child  should  be  isolated  until  the  rash  has  com- 
pletely disappeared. 

If  the  child  is  allowed  to  scratch  the  eruption,  scars 
may  be  left  permanently  in  the  skin. 

Diphtheria 

The  germs  of  diphtheria  attack  the  mucous  membranes 
of  the  body,  especially  those  of  the  nose  and  throat,  and 
cause  severe  poisoning  of  the  system. 

Symptoms. — When  a  child  is  exposed  to  the  dis- 
ease the  symptoms  may  be  delayed  for  several  days. 
Children  who  have  been  exposed  to  the  disease  should  be 
frequently  examined  by  their  physician. 

The  most  frequent  sites  of  attack  are  the  tonsil,  larynx 
and  nose.  On  the  tonsil  we  notice  at  first  small  grayish 
patches,    which,    becoming    larger,    join    one    another. 


148  HOW  TO  TAKE  CARE  OF  THE  BABY 

Patches  extend  toward  the  uvula  and  other  parts  of  the 
throat,  and  when  they  spread  to  the  larynx  they  cause 
great  difficulty  in  breathing  and  speaking. 

Any  continued  bloody  mucous  discharge  from  the  nose 
not  due  to  a  blow,  or  fall,  or  other  injury,  should  be  con- 
sidered a  case  of  diphtheria  until  the  contrary  has  been 
proved  by  examination  at  a  laboratory. 

The  onset  of  symptoms  is  very  slow,  the  temperature 
is  often  not  above  101°-102°  F.  There  is  loss  of  appe- 
tite, apathy  and  restlessness.  There  may  be  slight  pain  in 
swallowing. 

Treatment. — Antitoxin  should  be  administered  as 
early  as  possible.  Delay  in  its  use  makes  the  outlook  very 
bad.  In  doubtful  cases  it  should  always  be  given,  as  it 
can  do  no  harm. 

Quarantine. — ^The  length  of  time  in  quarantine  must 
be  decided  by  the  physician  in  charge. 

As  a  precautionary  measure,  every  member  of  the 
household  should  be  treated  with  antitoxin. 

Measles 

S3miptoms. — Measles  appears  about  ten  to  fourteen 
days  after  exposure.  It  is  a  very  contagious  disease  and 
may  be  carried  by  clothing  and  other  objects. 

The  onset  begins  with  redness  and  running  of  the  eyes, 
which  are  also  sensitive  to  light,  discharge  from  the  nose, 
and  a  dry  cough.  The  child  appears  to  have  caught  a  se- 
vere cold.  There  is  loss  of  appetite  and  fever,  which  may 
rise  to  103°  or  104°  F.  The  third  or  fourth  day  a  rash 
appears  on  the  face  and  behind  the  ears.  It  consists  of 
small,  dark-red,  raised  spots,  which  often  form  groups, 
and  lasts  about  three  or  four  days.  There  may  be  itching 
of  the  skin. 

Treatment. — The  child  should  be  given  a  hot  bath 
and  then  be  put  to  bed  at  once  in  a  well  ventilated  room, 


A   MOTHER'S   GUIDE  149 

with  the  shades  drawn  down  to  darken  it.  An  older  child 
can  wear  a  green  celluloid  eye  shade  such  as  clerks  often 
use,  and  which  will  be  found  very  soothing.  The  eyes 
should  be  bathed  every  three  hours  in  the  day  with  a 
warm  boric  acid  solution,  one  teaspoonful  to  one  pint  of 
water.  Only  fluid  diet  should  be  given  while  the  tem- 
perature is  above  normal.  The  bowels  must  be  kept  open. 
For  restlessness  or  high  temperature  see  treatment  under 
Pneumonia.  When  there  is  much  itching  of  the  skin, 
cold  cream  or  cocoa  butter  rubbed  on  the  body  and  limbs 
will  relieve  it  greatly.  If  the  cough  is  very  severe,  treat 
as  under  Bronchitis. 

Quarantine. — The  child  should  stay  in  bed  three 
days  after  the  temperature  has  returned  to  normal,  and 
should  be  quarantined  for  two  weeks  thereafter. 

The  most  frequent  complication  of  measles  in  infants  is 
pneumonia. 

German  Measles 

This  is  a  contagious  disease,  which  resembles  measles, 
but  is  not  nearly  so  severe.  It  makes  its  appearance  in 
from  one  to  three  weeks  after  exposure,  and  lasts  only 
from  three  to  five  days. 

Symptoms. — The  child  becomes  drowsy,  has  slight 
fever  and  a  sore  throat.  The  rash  appears  on  the  first  or 
second  day  of  the  illness;  it  begins  on  the  face  and 
spreads  over  the  rest  of  the  body.  It  fades  so  rapidly 
that  the  face  may  be  clear  before  the  arms  and  legs  are 
covered  with  it.  The  glands  at  the  back  of  the  neck  are 
often  swollen. 

Treatment. — The  child  should  be  kept  in  bed  on  a 
fluid  diet  for  a  few  days,  and  his  bowels  should  be  at- 
tended to.    No  other  treatment  is  necessary  in  most  cases. 

Quarantine. — The  child  should  be  isolated  for  a 
week  after  the  disappearance  of  the  rash. 


150  _  HOW  TO  TAKE  CARE  OF  THE  BABX 

Scarlet  Fever 

The  period  of  incubation  varies  from  a  few  hours  to 
seven  days.  This  disease  is  carried  by  clothing  and  other 
objects  that  have  been  in  contact  with  the  patient.  Such 
articles  have  been  known  to  cause  an  outbreak  after  a 
lapse  of  years. 

Symptoms. — There  is  loss  of  appetite,  often  vomit- 
ing, constipation,  high  fever,  103°- 105°  F.,  the  breathing 
is  hurried,  and  there  is  restlessness,  sleeplessness  and 
headache.  The  throat  is  inflamed  and  sore  and  there  is 
difficulty  in  swallowing.  The  tongue  is  coated,  and  red  at 
the  tip  and  edges.  The  rash  appears  after  about  twenty- 
four  hours  first  on  the  neck  and  chest  and  spreads  rap- 
idly all  over  the  body.  It  consists  of  small  red  points, 
sometimes  isolated,  at  other  times  blended  into  a  dull,  red 
flush ;  it  lasts  from  five  to  seven  days.  After  this  the 
skin  begins  to  peel  ofif  in  small  flakes,  especially  notice- 
able on  the  palms  and  soles.  The  peeling  may  last  any- 
where from  two  to  six  weeks,  during  which  time  strict 
quarantine  should  be  maintained.  It  is  most  contagious 
while  the  skin  is  peeling. 

Treatment. — The  most  common  complications,  in- 
flammation of  the  kidneys  and  of  the  ears,  are  much  to  be 
dreaded,  and  for  this  reason  a  physician  should  be  in  con- 
stant attendance.  Before  his  arrival  the  child  should  be 
put  to  bed  (see  chapter  on  Sick  Room).  Only  fluid  diet 
should  be  given,  preferably  milk,  until  the  fever  has 
dropped ;  then  cereals  and  a  vegetable  diet  are  permitted. 
No  meat  or  animal  food  whatever,  including  meat  soups, 
meat  broths,  fish,  eggs,  etc.,  should  be  allowed  until  three 
or  four  weeks  after  the  temperature  has  been  normal. 

Mumps 

This  is  a  contagious  disease  which  afifects  the  salivary 
glands,  and  appears  from  one  to  three  weeks  after  ex- 
posure. 


A   MOTHER'S   GUIDE  151 

Symptoms. — The  child  feels  sick,  chilly,  drowsy  and 
feverish.  The  temperature  varies  from  1(X)°-103°  F.  A 
swelling  soon  appears  below  and  in  front  of  one  ear, 
which  pushes  the  lobe  of  the  ear  out,  and  feels  doughy  to 
the  touch.  There  is  also  pain  in  moving  the  jaws.  The 
other  glands  below  the  jaws  may  be  swollen  and  the  face 
is  often  distorted.  Very  often  the  gland  below  the  other 
ear  is  also  affected.    The  disease  lasts  about  a  week. 

Treatment. — The  child  should  be  put  to  bed  and 
only  fluid  or  semi-fluid  diet  given  during  the  next  few 
days.  When  the  pain  is  severe,  hot  compresses  applied  to 
the  parts  will  be  found  very  soothing.  In  less  painful 
cases,  ordinary  cotton  batting  bandages  over  the  glands 
will  suffice. 

Quarantine. — The  child  should  be  isolated  for  three 
weeks  from  the  commencement  of  the  disease. 

DISEASES  OF  THE  SKIN 

A  few  of  the  more  common  diseases  of  the  skin  are 
described  below. 

Eczema 

Eczema  is  characterized  by  inflammation  and  marked 
itching  of  the  skin,  which  is  thickened,  moist,  and  shows 
crusts  and  fissures.  Serum  exudes  and  soon  forms  crusts. 
In  children  it  usually  appears  on  the  face  and  scalp. 

The  treatment  is  not  very  satisfactory,  and  takes  a  long 
time.  The  child's  diet  and  hygiene  must  be  attended  to. 
As  there  are  so  many  varieties  of  eczema,  which  are  often 
mistaken  for  different  diseases  of  the  skin,  it  is  best  to 
obtain  the  advice  of  a  physician.  The  eruption  may  with 
advantage  be  covered  with  a  bland  ointment,  like  Lassar's 
paste,  which  can  be  obtained  from  any  drug  store.  Water 
must  never  be  allowed  to  touch  the  eruption,  but  sweet  oil 
used  instead  for  cleansing  purposes. 


152  HOW  TO  TAKE  CARE  OF  THE  BABY 

Eczema  of  Scalp,  or  Milk  Crust 

This  consists  of  yellow  or  gray  crusts  which  matt  the 
hair  together,  and  occurs  only  in  infants.  The  scalp 
should  be  soaked  with  an  ointment  made  of  vaseline  con- 
taining five  per  cent,  of  resorcin.  The  hair  should  be  cut 
short  if  it  interferes  with  the  application  of  the  ointment. 
An  old  handkerchief  or  a  piece  of  muslin  should  have 
some  of  the  ointment  spread  on  it  and  then  tied  over  the 
child's  head,  so  as  to  keep  the  crusts  constantly  moist. 
This  should  be  repeated  morning  and  evening  for  three 
or  four  days,  when  the  scalp  should  be  washed  with  soap 
and  water,  and  the  crusts  removed  with  a  fine  tooth  comb. 
Severe  cases  need  to  have  this  treatment  repeated. 

Poison  Ivy 

This  is  an  inflammation  of  the  skin  marked  by  intense 
redness  and  blisters  containing  serum  and  pus  and  at- 
tended by  itching  or  burning.  It  usually  occurs  on  the 
hands  and  face  after  contact  with  poison  ivy,  and  cer- 
tain medicinal  substances. 

Treatment. — Soothing  lotions  should  be  used,  such 
as  solutions  of  sodium  bicarbonate  or  boric  acid.  Some 
persons  are  at  once  relieved  by  dusting  powders  such  as 
bismuth  subnitrate,  lead  acetate,  etc. 

Prickly  Heat 

Excessive  heat  accompanied  by  profuse  perspiration  is 
responsible  for  this  eruption,  which  occurs  mostly  upon 
the  trunk  and  consists  of  small,  bright  red  pimples  and 
blisters  which  are  crowded  together  but  remain  separate. 
There  is  itching,  tingling  or  burning. 

Treatment. — Light  clothing  and  frequent  cold  baths 


A   MOTHER'S   GUIDE  153 

are  indicated.  Cooling  lotions  or  solutions  of  bicarbonate 
of  soda  or  boric  acid  should  be  applied  to  the  skin,  fol- 
lowed by  dusting  powders,  such  as  oxide  of  zinc,  bis- 
muth, etc. 

Hives 

Hives  is  an  inflammation  of  the  skin,  characterized  by 
whitish  or  pinkish  flattened  or  round  elevations  of  the 
skin  marked  by  intense  itching  or  burning.  The  eleva- 
tions look  exactly  like  mosquito  bites  or  the  sting  of  the 
nettle ,  they  may  remain  isolated  or  become  joined  to- 
gether. Sometimes  there  is  swelling  of  the  underlying 
skin,  especially  about  the  eyelids.  Ordinarily  the  inflam- 
mation lasts  from  a  few  hours  to  a  few  days. 

Hives  may  be  caused  by  contact  with  certain  plants  or 
the  bites  of  some  insects  or  by  certain  articles  of  food, 
as  shell  fish,  pickles,  etc.,  and  certain  drugs,  as  quinine, 
copaiba,  etc.  The  cause  must  be  ascertained  and  re- 
moved. 

Treatment. — Bran  baths  often  relieve  the  condition. 
Carbolated  ointment  applied  to  the  worst  spots  will  at 
once  relieve  the  itching  and  burning. 

No  matter  what  the  cause,  a  cathartic  should  always  be 
given. 

Scabies,  or  the  Itch 

This  is  a  contagious  affection  due  to  the  presence  of 
a  parasite,  which  burrows  under  the  skin,  the  favorite 
positions  being  between  the  fingers,  at  the  elbows  and 
between  the  thighs.  The  irritation  causes  itching  all  over 
the  body,  which  soon  shows  scratch  marks  and  excoria- 
tions. 

Treatment. — All  clothing  recently  worn  should  be 
boiled  or  fumigated.    All  the  affected  parts  of  the  skin 


154  HOW  TO  TAKE  CARE  OF  THE  BABY 

should  be  thoroughly  rubbed  morning  and  evening  with 
sulphur  ointment,  one  ounce  powdered  sulphur  and  four 
ounces  lard,  well  mixed  together.  The  symptoms  will 
speedily  disappear  in  a  few  days. 

Intertrigo 

Intertrigo  is  an  intense  redness  of  the  skin  and  occurs 
when  moist  surfaces  of  the  skin  touch  each  other.  The 
inflammation  is  caused  mostly  by  neglecting  to  provide 
the  child  with  clean,  dry  diapers,  but  it  may  be  brought 
about  by  acid  urine  or  stools,  excessive  perspiration  and 
friction.  The  most  frequent  sites  are  between  the  but- 
tocks, between  the  thighs  and  in  the  folds  of  the  groin. 

Treatment. — The  parts  must  be  kept  dry  with  tal- 
cum powder  or  boric  acid  powder.  The  diapers  must  be 
changed  as  soon  as  they  are  wet. 

A  quicker  way  is  to  leave  off  the  diapers  in  a  warm 
room  and  to  expose  the  inflamed  areas  to  the  air  for  a 
few  hours  a  day. 

Applications  of  zinc  ointment  or  boric  acid  ointment 
are  very  healing.  ^Vhen  these  are  applied  no  powder 
should  be  used. 

FOOD  RECIPES 

Albumen  Water. — Take  the  white  of  one  fresh  egg, 
divide  it  in  several  directions  with  a  sharp  steel  knife, 
add  half  a  pint  of  cold  boiled  water,  and  a  pinch  of  salt. 
Shake  thoroughly,  or  use  an  egg  beater,  and  give  it  cold, 
either  from  the  bottle  or  with  a  spoon. 

Rice  Water. — Wash  one  heaping  tablespoonful  of 
rice,  let  it  soak  overnight,  then  add  a  pint  of  water  and 
a  pinch  of  salt.  Boil  for  three  or  four  hours,  or  until 
the  grains  of  rice  are  quite  soft.    Water  must  be  added 


A  MOTHER'S  .GUIDE  155 

from  time  to  time  to  keep  the  quantity  up  to  a  pint. 
Strain  it  through  muslin. 

Barley  Water. — Barley  water  from  the  grains  is 
made  in  the  same  way,  and  in  the  same  proportions,  as 
rice  water. 

When  made  from  prepared  barley  flour,  or  Robinson's 
Patent  Barley,  a  little  cold  water  is  added  to  one  level 
tablespoonful.  This  is  carefully  stirred  to  make  a  very 
thin,  smooth  paste,  and  then  poured  into  a  pint  of  boil- 
ing water  containing  a  pinch  of  salt.  This  should  be 
boiled  in  a  double  boiler  for  thirty  minutes,  strained,  and 
enough  water  added  to  bring  it  up  to  the  original  pint. 

Dextrinized  Barley  Water. — After  making  barley 
water  and  straining  it,  allow  it  to  cool  to  about  100° F., 
and  add  one  teaspoonful  of  Cereo  to  it,  stir  and  allow 
to  stand  for  ten  minutes,  then  cool  it  and  mix  it  with  the 
milk  formula.  In  some  feeding  cases  dextrinized  barley 
water  is  more  easily  digested  than  plain  barley  water. 

Oatmeal  Water. — One  tablespoonful  of  oatmeal  to 
one  pint  of  water,  boil  three  hours  and  add  enough  water 
to  make  a  pint. 

Wheat  Water. — This  is  made  exactly  the  same  as 
the  oatmeal  water  and  in  the  same  proportions. 

Barley,  oatmeal,  rice,  or  wheat  water  can  all  be  made 
from  the  prepared  flours,  or  from  the  grains,  and  all  are 
made  in  the  same  proportions,  and  in  the  same  way,  as 
the  recipes  given  for  rice  and  barley  water. 

Gruels  or  Jellies  From  Rice,  Oats,  Wheat  or  Barley. 
— These  can  be  made  in  the  same  manner,  and  either 
from  the  grains  or  the  flour,  but  the  proportions  are  from 
two  to  four  level  tablespoon fuls  of  the  flour  to  a  pint  of 
water.  When  the  grains  are  used,  two  tablespoon  fuls 
are  taken,  and  soaked  overnight,  then  cooked  for  four 
hours.  They  should  be  strained,  and  when  milk  is  to 
be  added,  it  must  be  stirred  in  directly  after  removing 
the  gruel  from  the  fire. 


.156  HOW  TO  TAKE  CARE  OF  THE  BABY 

Beef  Juice. — There  are  two  ways  of  making  beef- 
juice.  The  first  is  to  take  one-half  pound  of  round  steak, 
cut  thick.  Broil  it  slightly,  then  press  out  the  juice  with  a 
lemon  squeezer  or  meat-press  and  add  a  little  salt.  The 
second  method  is  to  have  the  round  steak  finely  chopped, 
and  put  it  in  a  covered  jar,  then  pour  in  enough  cold 
water  to  cover  it  and  add  salt.  Cover  the  jar  and  stand 
it  on  ice  for  six  hours  or  more,  shaking  it  from  time 
to  time.  Empty  the  jar  into  a  piece  of  cheesecloth  and 
strain.  This  method  is  not  quite  so  palatable,  although 
children  do  not  seem  to  object  to  it,  and  it  has  the  ad- 
vantage of  being  more  nutritious  and  much  more  eco- 
nomical. 

Beef -juice  can  be  warmed  slightly  by  pouring  it  in  a 
small  cup,  and  then  placing  this  in  a  larger  one  contain- 
ing warm  water.  It  should,  however,  not  be  warmed 
enough  to  coagulate  the  albumen. 

Mutton,  Chicken,  Veal  and  Beef  Broths. — Take  one 
pound  of  meat  free  from  fat,  cut  in  small  pieces,  cover 
with  one  pint  of  cold  water,  add  a  pinch  of  salt,  and 
allow  it  to  simmer  for  three  or  four  hours,  adding  water 
as  necessary.  It  should  cook  down  to  about  half  a  pint. 
Strain  and  when  cold,  remove  the  fat.  It  can  be  given 
hot,  or  in  some  cases  cold,  in  the  form  of  jelly. 

Scraped  Beef. — A  rare  piece  of  sirloin  steak  is 
slightly  broiled.  Then,  with  a  dull  knife,  this  is  scraped 
or  shredded,  taking  only  the  pulp  for  use.  From  a  tea- 
spoonful  to  a  tablespoon ful  may  be  given,  with  a  little 
salt. 

Prune  Pulp. — Cook  the  prunes  slowly  in  a  porcelain 
saucepan  with  a  little  water  until  they  are  quite  soft. 
Then  strain  or  rub  them  through  a  coarse  sieve. 

Whey. — Take  one  pint  of  fresh  cow's  milk  and  warm 
it,  but  not  above  about  1CK)°F.  Add  two  teaspoonfuls 
of  Fairchild's  essence  of  pepsin,  or  liquid  rennet.     Stir 


A   MOTHER'S  .GUIDE  157 

for  a  minute,  then  allow  it  to  stand  until  firmly  jellied, 
then  break  up  the  curd,  with  a  fork,  and  strain  off  the 
whey  through  muslin,  then  pasteurize  it  and  put  it  in 
the  ice-box.  One  pint  of  milk  will  yield  about  eleven 
ounces  of  whey.  Since  the  introduction  of  protein  milk, 
whey  is  used  very  little  in  difficult  feeding  cases. 

Junket. — This  is  for  older  children  and  is  made  in 
the  same  manner  as  whey,  except  that  two  teaspoonfuls 
of  sugar  can  be  stirred  in  with  the  rennet,  and  that  va- 
nilla, cinnamon  or  grated  nutmeg  may  also  be  added  as 
a  flavoring.  As  soon  as  the  mixture  is  firmly  coagulated, 
place  it  in  the  ice-box  to  get  thoroughly  cold.  Do  not 
stir  it  nor  strain  it. 

Coddled  Egg. — Into  a  saucepan  of  boiling  water  a 
fresh  egg  is  placed  without  removing  the  shell.  The 
water  is  immediately  removed  from  the  fire,  and  the  egg 
left  in  it  for  five  minutes.  The  white  should  then  be  of 
a  jelly-like  consistency. 

Bran  Biscuits. — Take: 

1  pint  of  flour, 

1  quart  bran  (straight), 

12  tablespoonfuls  molasses, 

1  teaspoon ful  baking  soda, 

1  teaspoon  ful  salt, 

1  generous  pint  of  milk. 

Mix  and  bake  in  muffin  rings.  These  will  make  about 
twenty  rings. 

These  bran  biscuits  are  very  efficacious  in  overcoming 
constipation  in  nursing  mothers.  Usually  two  biscuits 
a  day  will  be  sufficient. 

Corn-Meal  Mush. — 1  quart  of  water. 

1  teaspoonful  of  salt. 

1  pint  of  granulated  corn-meal. 

Add  the  salt  to  the  water,  and  when  boiling,  sprinkle 
in  the  corn-meal,  slowly  stirring  all  the  while.    Boil  rap- 


158  HOW  TO  JAKE  CARE  OF  THE  BABY 

idly  for  ten  minutes,  then  push  the  kettle  over  a  slow 
fire  to  cook  for  two  hours.    Serve  warm  with  milk. 

This  will  help  to  increase  the  flow  of  milk  in  nursing 
mothers. 

MEASURES 

The  following  list  of  measures  will  be  found  useful 
when  making  up  food  formulas  or  giving  medicines. 

1  ounce  of  liquid  equals  2  tablespoonfuls. 

Or  equals  4  dessertspoonfuls. 

Or  equals  8  teaspoon  fuls. 

Or  equals  8  drams. 

1  tablespoon ful  equals  2  dessertspoonfuls. 

Or  equals  4  teaspoon  fuls. 

1  dessertspoonful  equals  2  teaspoonfuls. 

A  cup  or  tumbler  equals  ^  pint. 

An  ordinary  wineglass  equals  2  ounces. 

For  Measuring  Sugar. — 1  heaping  tablespoonful  of 
cane  sugar  equals  1  ounce. 

3  level  tablespoonfuls  of  milk  sugar  equal  1  ounce. 

COMMON  REMEDIES 

Some  children  require  smaller  and  others  larger  doses 
of  cathartics  than  those  given  below,  but  the  following 
amounts  should  produce  at  least  two  good  movements  six 
or  eight  hours  after  administration. 

Castor  Oil: 

Under  3  months  old,  ^^  to  1  teaspoonful. 

From  3  to  6  months  old,  1  to  2  teaspoonfuls. 

From  6  to  9  months  old,  2  to  3  teaspoonfuls. 

From  9  to  12  months,  4  to  6  teaspoonfuls. 

Older  children,  1  to  2  tablespoonfuls. 

When  children  object  to  castor  oil,  it  can  be  made  pala- 
table in  two  ways : 


A   MOTHER'S   GUIDE  159 

1.  Stir  it  with  double  the  amount  of  orange  juice ;  or 

2.  Mix  it  well  with  an  equal  amount  of  sirup  of  sarsa- 
parilla  and  add  a  dash  of  vichy.  After  cooling  on  the  ice, 
shake  well  and  give  at  once. 

Calomel. — Under  1  month  old,  3/10  grain. 

From  1  to  3  months  old,  ^  to  ^  grain. 

After  this  age  yi  grain  may  be  added  for  every  three 
months  of  age,  making  the  doses,  1  grain  at  1  year,  and 
2  grains  at  2  years ;  but  more  than  2  grains  should  rarely 
be  given  at  any  age.  The  tablets  should  be  dissolved  in 
water  before  administration,  and  it  is  better  to  divide  the 
dose,  giving  1/10  or  3^  or  ^  grain  tablets  every  10  to  15 
minutes,  until  the  entire  amount  has  been  taken,  than  to 
give  it  all  at  once. 

Milk  of  Magnesia. — Phillips'  Milk  of  Magnesia. 
Dose  y2  to  I  teaspoon  ful,  given  in  the  ten  o'clock  bottle 
at  night. 

This  is  the  best  laxative  for  infants  under  one  year  old, 
and  can  be  used  for  months. 

Citrate  of  Magnesia. — Dose :  Half  a  tumblerful  early 
in  the  morning,  for  children  over  two  years  of  age.  It 
is  a  good  substitute  for  castor  oil,  when  preceded  by  a 
dose  of  calomel,  and  has  the  advantage  of  being  pleasant 
to  take. 

Sirup  of  Ipecac  or  Wine  of  Ipecac. — Dose :  One  tea- 
spoonful,  repeated  if  necessary.  Used  chiefly  in  spas- 
modic croup,  as  an  emetic.  No  nursery  should  be  zvith- 
oiit  it.  It  can  also  be  given  when  a  child  eats  any  highly 
indigestible  food,  and  it  is  desirable  to  empty  the  stomach. 

Brown  Mixture. — This  is  an  excellent  cough  mix- 
ture, universally  employed.  As  it  contains  a  small 
amount  of  paregoric,  mothers  and  nurses  are  cautioned 
not  to  give  too  large  doses,  nor  to  continue  this  remedy 
longer  than  necessary. 

The  doses  are  as  follows :  a  child  6  months,  10  drops ; 
1  year,  IS.drops ;  18" months,  20  drops ;  2  years,  25  drops ; 


160     HOW  TO  TAKE  CARE  OF  THE  BABY 

3  years,  30  drops;  4  years,  40  drops;  5  years,  1  tea- 
spoonful. 

The  dose  can  be  repeated  every  2  or  3  hours,  up  to  4  or 
5  doses  a  day. 

Rhubarb  and  Soda  Mixture. — This  mixture  is  recom- 
mended as  a  mild  laxative  for  children  of  all  ages.  The 
dose  is  a  teaspoonful  for  every  year  of  age,  i.  e.,  one-half 
teaspoonful  at  6  months,  3  teaspoonf uls  at  3  years,  etc.  It 
can  be  given  two  or  three  times  a  day  one-half  hour  be- 
fore meals,  until  good  results  are  obtained. 

Compressed  Liquorice  Powder. — Stirred  up  in  milk, 
this  powder  is  an  excellent  mild  laxative  for  older  chil- 
dren. Dose  for  a  child  three  years  old,  one-half  teaspoon- 
ful ;  for  a  child  five  years  old,  one  teaspoonful. 

Dobell's  Solution. — This  antiseptic  solution,  diluted 
with  one  or  two  parts  of  warm  boiled  water,  can  be  used 
as  a  spray  for  colds  in  the  nose  or  throat.  Mixed  with 
three  parts  warm  water  it  can  be  employed  as  an  efficient 
gargle. 

INJECTIONS,  SUPPOSITORIES,  AND  IRRIGA- 
TIONS 

Caution  Against  Their  Prolonged  Use. — Although 
the  use  of  any  of  these  remedial  measures  for  constipa- 
tion should  never  become  a  fixed  habit,  as  serious  harm 
may  result  from  their  prolonged  use,  still  it  is  important 
that  a  mother  should  be  familiar  with  the  different  modes 
of  administering  them,  as  in  many  minor  ailments  one  or 
the  other  is  often  the  only  remedy  required. 

Suppositories  and  Enemas. — In  a  case  of  ordinary 
constipation  a  soap  suppository  can  be  used.  It  is  made 
by  cutting  out  a  small  piece  of  castile  soap  as  thick  as  a 
lead  pencil,  and  about  an  inch  long.  A  gluten  suppository 
is  equally  good,  and  can  be  obtained  at  most  drug  stores. 


A   MOTHER'S   GUIDE  161 

A  sweet  oil  enema  of  an  ounce  or  two,  depending  on 
the  child's  age,  will  also  be  found  useful. 

If  a  more  efficient  enema  is  required,  mix  one  table- 
spoonful  of  glycerine  with  three  of  sweet  oil. 

The  enemas  are  best  given  with  a  small  rubber  bulb 
syringe,  the  rubber  point  should  be  well  oiled  before  in- 
serting it  and  the  solution  injected  slowly. 

Whenever  suppositories  or  enemas  are  used,  the  child's 
buttocks  must  be  held  together  for  ten  or  fifteen  minutes 
in  order  to  get  proper  results. 

Colon  Irrigation. — When  there  is  much  colic,  flatu- 
lence and  a  distended  abdomen,  or  at  the  onset  of  acute 
indigestion  or  illness,  it  is  advisable  to  give  a  colon  irriga- 
tion. This  is  done  by  means  of  a  No.  20,  22,  or  24  French 
catheter  attached  to  a  fountain  syringe,  which  should  be 
suspended  not  more  than  two  or  three  feet  above  the 
child's  buttocks. 

Use  water  at  about  100°F.,  or  as  hot  as  can  be  comfort- 
ably borne  by  the  hand,  and  add  one  teaspoonful  of  table 
salt  to  every  pint  used.  The  reason  for  the  addition  of 
salt  is,  that  it  is  less  irritating  than  the  use  of  plain  water. 
The  amount  to  be  injected  varies  for  different  ages,  but 
enough  must  be  used  to  clean  out  the  bowels  thoroughly. 
One  quart  will  be  sufficient  for  an  infant  under  six 
months  old,  one  and  a  half  quarts  for  a  child  one  year  old, 
and  two  quarts  for  a  child  under  four  years  of  age.  Chil- 
dren will  not  retain  these  amounts,  for  the  greater  part  of 
the  water  is  expelled  during  the  irrigation.  In  some  cases 
soda  bicarbonate  is  used  instead  of  the  salt. 

How  to  Give  a  Colon  Irrigation. — The  child  must  be 
laid  on  his  back  on  the  bed,  with  a  rubber  sheet  and  a 
thick  pad  under  him.  On  the  floor  should  be  a  basin  or 
pail,  so  arranged  that  the  water  will  all  run  into  it  from 
the  sheet.  The  catheter  should  be  oiled  its  entire  length 
with  vaseline,  and  a  little  water  allowed  to  run  through 


162  HOW  TO  TAKE  CARE  OF  THE  BABY 

it  into  the  basin  to  insure  its  being  at  the  proper  tempera- 
ture, then  raise  the  child's  legs,  bend  the  thighs,  and  sepa- 
rate them  enough  to  allow  the  catheter  to  be  inserted. 
Never  use  any  force  in  doing  this,  as  carelessness  may 
cause  injury.  If  the  catheter  is  correctly  inserted  and  as 
soon  as  the  water  distends  the  bowel,  it  will  slide  in  with- 
out any  resistance,  often  for  its  entire  length,  but  no  at- 
tempt must  be  made  to  push  it  with  any  but  the  lightest 
pressure.  Very  often  the  catheter  is  forced  out  with  the 
water  which  is  expelled  from  the  bowel.  It  should  then 
be  inserted  again,  until  the  return  flow  is  clear. 

When  about  half  the  amount  has  been  given,  discon- 
nect the  catheter,  leaving  it  in  the  rectum,  and  allow  the 
water  from  the  bowels  to  run  out.  Pressure  on  the  lower 
part  of  the  abdomen  will  assist  in  forcing  the  water  out. 
When  the  flow  ceases,  connect  the  catheter  again  to  the 
fountain  syringe,  and  proceed  as  before. 

DON'T 

Don't  wean  a  baby  because  the  mother's  milk  looks 
pale,  like  diluted  skimmed  milk.    It  often  looks  that  way. 

Don't  neglect  cold  hands  and  feet,  as  an  attack  of  indi- 
gestion, pneumonia,  etc.,  may  follow. 

Don't  swaddle  the  baby  with  clothes,  so  that  he  per- 
spires, as  he  is  then  very  apt  to  catch  cold. 

Don't  forget  to  attend  to  the  regularity  of  the  bowels. 

Don't  play  with  the  baby  after  his  feeding,  nor  excite 
him  at  any  time,  especially  before  going  to  bed  at  night. 

Don't  make  any  sudden  or  unusual  noise  in  the  pres- 
ence of  the  baby. 

Don't  take  up  the  baby  every  time  he  cries;  you  will 
spoil  him. 

Don't  feed  the  baby  every  time  he  cries ;  you  will  upset 
his  digestion. 


A   MOTHER'S   GUIDE  163 

Don't  allow  friends  or  strangers  to  kiss  your  baby,  and 
don't  kiss  your  own  baby  on  the  mouth. 

Don't  allow  any  one  with  a  cough  near  your  baby. 

Don't  forget  that  fresh  air  is  essential  to  a  baby's 
health. 

Don't  neglect  a  "little"  diarrhea. 

Don't  forget  to  give  a  child  a  good  dose  of  castor  oil 
whenever  he  is  upset,  and  then  dilute  his  food  for  the 
next  few  feedings. 

Don't  forget  that  the  first  sign  of  a  disturbed  digestion 
is  often  restlessness  at  night. 

Don't  coax  the  baby  to  take  his  food ;  it  is  poison  when 
he  does  not  want  it ;  let  him  get  hungry  and  wait  for  the 
next  feeding. 

Don't  keep  on  giving  a  child  the  same  food  when  yoq 
know  it  is  disagreeing  with  him. 

Don't  give  a  vomiting  baby  a  rich  milk  mixture  con- 
taining much  cream,  or  sugar,  or  proprietary  foods. 

Don't  give  a  cold  bottle  to  a  baby. 

Don't  begin  any  change  of  food  by  giving  large  quanti- 
ties or  by  making  it  strong. 

Don't  forget  to  give  plenty  of  water  to  the  baby  when 
the  napkins  are  stained  a  yellow  or  brick-red  color. 

Don't  follow  your  friend's  advice ;  consult  your  physi- 
cian. 

Don't  forget  that  it  is  easier  to  avoid  trouble  than  to 
cure  it. 

Don't  forget  to  keep  a  note-book  recording  the  weight, 
the  feeding,  and  any  illnesses. 

Don't  leave  poisons  or  drugs  anywhere  within  reach  of 
a  child. 


INDEX 


INDEX 

PAGE 

Accidents    134 

Additional  food  during  first  year 62 

Adenoids    Ill 

Airing    14 

Airing,  Indoor   14 

Albumen  water 154 

Appetite,  Loss  of 7Z 

Appetite,  Peculiarities  of 76 

Articles  for  preparing  food 44 

Artificial  feeding  39 

Bad  habits  132 

Barley  water 55,  62,  155 

Barley  water,  Dextrinized  155 

Bath,  How  to  give  a 9 

Bath,  Bran,  soda,  starch,  salt,  sponge  or  mustard 11,  12 

Bathing   8 

Bathing,  Articles  for  9 

Bed,  The  baby's  3 

Bedding,  Care  of  3 

Bed   wetting    119 

Beef  juice  62,  156 

Bottle,  Drinking  from  Z7 

Bottle,  Nursing  45 

Bottle,  How  to  warm  a 46 

Bowels  and  bladder.  Training  of 118 

Bran  biscuits  157 

Breast  pump  34 

167 


168  INDEX 

PAGE 

Broths    156 

Bronchitis   106 

Bruised   fingers    136 

Burns  and  scalds  134 

Buttermilk   65 

Calomel    99,  159 

Castor  oil,  Constipation  increased  by 99 

Castor  oil,  Doses  158 

Cathartics,  Warning  against  95 

Chapin  dipper  44 

Chicken  pox   147 

Circumcision   128 

Clothing    4 

Clothing  of  older  children 6 

Clothing,  List  of,  for  young  baby 6 

Colds  and  their  causes 103 

Colds,  Prevention  of  103 

Colds,  Chronic   104 

Colic  and  wind  85 

Constipation  95 

Constipation  in  nursing  baby 96 

Constipation  in  bottle-fed  baby 96,  97 

Constipation  in  older  children 97 

Contagious  diseases 145 

Convulsions   136 

Croup  kettle  105 

Croup,  Spasmodic  108 

Cry,  The    129 

Cough,  Remedy  for  107 

Cows,  Care  of   42 

Cow's  milk,  Composition  of 40 

Cup,  Teaching  to  drink  from ^ 38 

Development   120 

Diarrhea,  In  nursing  infant 90 


INDEX  169 

PACK 

Diarrhea,  Severe,  in  nursing  infant 91 

Diarrhea,  In  bottle-fed  infant 91 

Diarrhea,  Severe,  in  bottle-fed  infant 92 

Diarrhea,   Summer    92 

Diarrhea,  Comphcations  of  94 

Diet  from  12  to  IS  months 68 

Diet  from  15  to  18  months 68 

Diet  from  18  months  to  2  years 69 

Diet  from  2  to  3  years  of  age 70 

Diet  from  4th  to  10th  year 71 

Diphtheria    147 

Diseases  of  the  skin 151 

Don't    162 

Douches,  Cold   12 

Earache  109 

Eczema    151 

Eczema  of  scalp,  or  milk  crust 152 

Egg,  White  of   63 

Egg,  Coddled   157 

Enemas   160 

Exercise    16 

Eyes,  Care  of  the 13 

Fat,  Necessity  of  58 

Feeding,  Artificial  39 

Feeding,  Mixed   25,  31,  36 

Feeding  schedules  54 

Feeding,  General  directions  for 59 

Feeding,  Position  during  59 

Feeding,  Waking  for  60 

Feeding,  Time  allowed  for 60 

Feeding,  Intervals  between 61 

Feeding,  Indications  for  changing 80 

Feeding  during  illness  81 

Feeding  after  illness 81 


170  INDEX 

PAGE 

Feeding,  Night   56,  60 

Feeding  in  hot  weather,  Rules  for 94 

Foot  covering  5 

Forbidden  articles  of  food 11 

Foreign  bodies  swallowed   134 

Foreign  bodies  in  nose,  ear  or  eye 135,  136 

Formula,  How  to  select  a 47 

Formula,  Increase  of  48 

Formula,  Preparation  of  suitable SO 

Formula,  Amount  in  53,  56 

Fumigation   144 

Gargle  (see  Dobell's  solution) 160 

Garments,  Outer   5 

Garments,  Night   5 

Genitals,  Care  of  13 

Glands,  Enlarged  Ill 

Gruels  62,  155 

Height  of  children   122 

Hiccough    108 

Hives   153 

Increasing  the  food.  Indications  for 48 

Increasing  the  food.  Indications  for  not 49 

Indigestion    80 

Indigestion  from  overfeeding  81 

Indigestion  from  excess  of  fat 82 

Indigestion  from  excess  of  sugar 83 

Injections    160 

Intervals,  Lengthening  of  61 

Intertrigo    154 

Irrigation,  Colon   161 

Jaundice    H^ 

Junket   157 


INDEX  171 

PAGE 

Kissing  babies    130 

Laxative  for  young  infants 97 

Lifting  a  baby  7 

Lifting  older  children 8 

Malnutrition  and  marasmus 100 

Mammala,  a  desiccated  milk 83 

Masturbation   133 

Meals,  Regular  hours  for 72 

Measles    148 

Measles,  German  149 

Milk,  Herd   40 

Milk  from  Holstein  or  Jersey  cows 41 

Milk,  Care  of   41,  43 

Milk,  Different  grades  of 50 

Milk,  Whole  Sr 

Milk— Sugar    52 

Milk,    Skimmed    59 

Milk  for  older  children 72 

Milk,   Condensed    83 

Milk  in  in  f ant's  breasts 134 

Milk  of  magnesia   159 

Mother's  milk.  Substitute  for 39 

Mumps    150 

Mustard  plaster  106 

Napkins,  Care  of 7 

Napkins,  Discoloration  on  80 

Night  terrors    113 

Nipples  and  breasts,  Care  of 22,  39 

Nose  bleed  135 

Nursery,  The    1 

Nursery,  The,  Ventilation  of 1 

Nursery,  The,  Heating  of 2 

Nursery,  The,  Temperature  of 2 


172  INDEX 

PACE 

Nursery,  The,  Lighting  of 3 

Nursing   21 

Nursing,  Conditions  prohibiting  21 

Nursing,  Schedule  for  24 

Nursing,  Abnormal  conditions  in 26 

Nursing,  Signs  of  overfeeding  in 27 

Nursing,  Too  quick  27 

Nursing,  Too  rich  milk  in 27 

Nursing,  Scanty  milk  in 29 

Nursing,  Poor  milk  in 30 

Nursing  mother's  guidance,  Rules  for 23,  24 

Oatmeal  jelly  98 

Oatmeal  water   98,  155 

Ohve  oil  58 

Orange  juice   63,  98 

Outings,  Rules  for  IS 

Pacifier,  The  133 

Patent  foods   84,  85 

Pasteurization  66 

Peptonization,  Directions  for  65 

Peptonized  milk 65 

Playing  with  babies  130 

Pneumonia    140 

Pneumonia,  Sponging  in 141 

Poison  ivy  152 

Preparation  of  a  baby's  food 44 

Prickly  heat 152 

Protein  milk 63 

Prune  juice  98 

Prune  pulp   » 156 

Quarantine  142 


INDEX  173 

PAGE 

Recipes,  Food  154 

Reducing  food,  Indications  for 49 

Remedies,   Common    158 

Rice  water  154 

Rickets    138 

Russian  oil   99 

Scabies,  or  the  itch 153 

Scales  for  babies  122 

Scarlet  fever  150 

Scraped  beef  156 

Scurvy  139 

Sickroom  in  contagious  diseases 142 

Sleep    17 

Sleeplessness,  its  causes 19 

Sprue  or  thrush  110 

Stables    41 

Sterilization   66 

Stings  of  insects  136 

Stools,  Normal 11 

Stools,  Effect  of  proprietary  foods  on 78 

Stools,  Effect  of  drugs  on 78 

Stools,  Curds  in  78 

Stools  showing  excess  of  fat 78 

Stools  showing  excess  of  protein 78 

Stools  showing  excess  of  sugar 79 

Stools,  Blood  in   79 

Stools  from  inactive  liver 79 

Sugars,  milk,  cane  or  malt 52 

Suppositories    95,  160 

Syrup  of  ipecac 108,  159 

Teeth,  Care  of  123 

Teething   123 

Tempwature,  The  115 


174  INDEX 

PAGE 

Thirst  from  heat  49 

Throat,  Examination  of   116 

Thrush  or  sprue  110 

Thumb   sucking   I33 

Thunderstorms,  Effect  of  44 

Tonsils  112 

Top  milk  50,  51,  56 

Toys  131 

Underwear    4 

Urine,  Retention  of  114 


Vacc 
Vom 
Vom 
Vom 
Vom 
Vom 
Vom 
Vom 
Vom 
Vom 
Vom 
Vom 
Vom 
Vom 
Vom 
Vom 
Vom 
Vom 


nation    128 

ting,  Causes  of 86 

ting  in  nursing  infants 86 

ting  in  bottle-fed  infants 87 

ting  from  overfeeding 87 

ting  from  too  rapid  feeding *~87 

ting  from  too  frequent  feeding 87 

ting  from  playing  with  babies 87 

ting  from  tight  binder 87 

ting  from  excess  of  fat 87 

ting  from  excess  of  sugar 88 

ting  from  chronic  constipation 88 

ting  from  habit 88 

ting  from  errors  in  diet 88 

ting,  General  treatment  for 89 

ting  from  acidosis   89 

ting  from  pyloric  stenosis 90 

ting  requiring  physician's  attention 89 


Weaning,  Reasons  for  early 36 

Weaning  in  summer  Zl 

Weaning,  Sudden  'ZT,  39 

Weaning  at  12  months 38 


INDEX  17? 

PAGE 

Weaning,  Selection  of  formula  in 38,  47 

Weight,  Loss  of 38 

Weight  of  average  normal  child 120 

Weights  and  measures  158 

Wet-nurse,  Selection  of  33 

Wet-nurse,  Treatment  of  34 

Wet-nurse's  own  infant   35 

Wet-nursing  32 

Wet-nursing,  Difficulties  of  32 

Wet-nursing,  Indications  for   32 

Wheat  water  155 

Whey   156 

Whooping  cough  146 

Worms    112 

Wounds  135 


University  of  California 

SOUTHERN  REGIONAL  LIBRARY  FACILITY 

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LOS  ANGELES,  CALIFORNIA  90095-1388 

Return  this  material  to  the  library  from  which  It  was  borrowed. 


I 


CAT     NO     24    161 


.,,,,^  .'^"''^''^''''"'"llllll 


D  000  165  123  1 


WS  113 
T969h 

1915 
Tweddell'  Francis 

How  to  take  care  of  the  baby. 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CAMFOI^NIA,  IRVINE 

IRVINE,  CALIFORNIA  92664 


